No transfusion is the best transfusion: a rare case

Abstract

Presence of antibodies against red cell antigens remains a major problem in thalassemia patients. b-thalassemia major patients do commonly suffer from alloimmunization, which is rarely seen in thalassemia intermedia patients. Association of multiple antibodies and antibody against high frequency blood group antigen further complicates the transfusion therapy. Advance immunohematological tests like adsorption, elution, and phenotyping are necessary along with antibody screening and identification. We present a case about a 25-year male thalassemia intermedia patient, whose blood sample when crossmatched found incompatible with more than 100 units of packed red blood cells. Various tests like direct and indirect antiglobulin (Coombs) tests, 3-cell panel, 4- cell panel, 10-, 11-, 16-cell panels, adsorption, elution, minor phenotyping were done to resolve the case. We found multiple alloantibodies with no autoantibody. The present case emphasizes on importance of minor phenotyping before first transfusion in all multitransfused patients, importance of immunohematological tests in resolving blood incompatibility and our experience of dealing high frequency antigen. 存在红细胞抗原的抗体仍然是地中海贫血患者的主要问题。 β地中海贫血症主要患者通常患有同种异体免疫，这在中间地贫患者中罕见。 针对高频血型抗原的多重抗体和抗体联合进一步使输血治疗复杂化。 推进吸附、洗脱和表型分型等免疫血液学试验发展与抗体筛查和鉴定具有同等必要性。 我们提出一个关于一名约25岁的男性中间型地贫患者的病例，发现其血液样本在交叉配型时与超过100个单位的浓缩红细胞不相容。 直接和间接抗球蛋白（库姆斯）测试、3细胞检测组、4细胞检测组、10细胞检测组、11细胞检测组、16细胞检测组、吸附、洗脱、微细表型分型等各种测试都是为解决这种情况。 我们发现多种同种抗体，没有发现自身抗体。 本病例强调了在所有多次输血的患者首次输血之前进行微细表型分型的重要性，免疫血液学测试在解决血液不相容的重要性以及我们处理高频抗原的经验。

Keywords

• Alloimmunization
• phenotyping
• adsorption
• elution.