Case report: massive postpartum transfusion of Jr(a+) red cells in the presence of anti-Jra

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Immunohematology

American National Red Cross

Subject: Medical Laboratory Technology

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ISSN: 0894-203X
eISSN: 1930-3955

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VOLUME 21 , ISSUE 3 (September 2005) > List of articles

Case report: massive postpartum transfusion of Jr(a+) red cells in the presence of anti-Jra

Shan Yuan / Rosalind Armour / Allison Reid / Khaled F. Abdel-Rahman / Michael Phillips / Dawn M. Rumsey / Theresa Nester

Keywords : anti-Jra, massive transfusion, hemolytic transfusion reaction

Citation Information : Immunohematology. Volume 21, Issue 3, Pages 97-101, DOI: https://doi.org/10.21307/immunohematology-2019-400

License : (Transfer of Copyright)

Published Online: 27-April-2020

ARTICLE

ABSTRACT

Jra is a high-prevalence antigen. The rare Jr(a–) individuals can form anti-Jra after exposure to the Jra antigen through transfusion or pregnancy. The clinical significance of anti-Jra is not well established. This study reports a case of a 31-year-old woman with a previously identified anti-Jra who required massive transfusion of RBCs after developing life-threatening postpartum disseminated intravascular coagulopathy. Despite the emergent transfusion of 15 units of Jra untested RBCs,she did not develop laboratory or clinical evidence of acute hemolysis. The patient’s anti-Jra had a pretransfusion titer of 4 and a monocyte monolayer assay (MMA) reactivity of 68.5% (reactivity > 5% is considered capable of shortening the survival of incompatible RBCs). The titer increased fourfold to 64 and the MMA reactivity was 72.5% on Day 10 posttransfusion. Review of laboratory data showed evidence of a mild delayed hemolytic transfusion reaction by Day 10 posttransfusion. Despite rare reports of hemolytic transfusion reactions due to anti-Jra in the literature,most cases,including this one, report that this antibody is clinically insignificant or causes only mild delayed hemolysis. Clinicians should be advised to balance the risks of withholding transfusion with the small chance of significant hemolysis after transfusion of Jr(a+) RBCs in the presence of anti-Jra.

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