[Detection and Treatment for Hemolytic Transfusion Reaction in Patient with Combined Antibody Consisted of Anti-Fy^a and Anti-Jk^b]

Objective: To investigate and assess hemolytic transfusion reaction in patient with complex and combined anti-Fy^a and anti-Jk^b which so as to provide a safety blood transfusion strategy.

Methods: ABO/Rh blood grouping, antibody screening and identification, and Coombs' tests were performed by the routine serological methods include manual tube and automatic blood group analyzer with matching micro-column gel cards from Diagnostic Grifols and Jiangsu LIBO. The hospital information system and laboratory information system were used to collect dada on patients' blood routine tests, liver and kidney function, coagulation, cardiac function, and other clinical indicators before and after blood transfusion were analyzed and compared in conjunction with the patients' clinical manifestations.

Results: The patient's blood group was A/CcDEe. Before two transfusion, the anti-body screening were positive which identification were anti-Fy^a and anti-Fy^a combined with anti-Jk^b respectively, while the Coomb's test were positive with anti-C₃ and anti-IgG combined with anti-C₃ respectively. No agglutination and hemolysis was observed in saline medium cross-matching test before two transfusion of Fy^a- red blood cell. But before re-transfusion agglutinated reaction was observed in cross-matching test by DG Gel ^®Coombs, which strength was 2+ on whether major or minor side. The patient developed soy sauce urine/hemoglobinuria and fever after transfused Fy^a- red blood cell again. Primary laboratory indicators were observed to be elevated, include C-reactive protein from 3.06 mg/L to 29.97 mg/L, total bilirubin from 21.4 μmol/L to 276.3 μmol/L, direct bilirubin from 8.4 μmol/L to 135.6 μmol/L, lactate dehydrogenase from 166 U/L to 1453 U/L. Urinary free hemoglobin test was 4+. The main laboratory indicators reflecting the heart, liver, kidney and circulatory coagulation function also have vary increased and gradually returned to normal after a week.

Conclusion: Jk^b-incompatible transfusion of the Kidd blood group system can lead to acute hemolytic transfusion reaction, but in emergency implementing incompatible transfusion due to IgG antibodies outside of the primary blood group (such as ABO/RhD) can ensure the implementation of emergency operation.