A Case Report of Acute Hemolytic Transfusion Reaction Caused by Lewis-a Antibody Incompatibility, and Merit of Antibody Screening Test after Open Heart Surgery

Hemolysis, hemoglobinuria, skin eruption and hypotension were noticed following transfusion of 11 units of fresh blood during mitral valve replacement in a 57-year-old man. Irregular antibody incompatibility was suspected. Further investigation revealed anti Lewis-a antibody. Three of 11 units of transfused blood were positive for the indirect Coombs test. The patient recovered without renal failure, and was discharged. One year later, he had urgent re-MVR due to malfunction of the prosthetic valve. Hemolytic transfusion reaction had occured after the administration of donor blood which had been showed to be compatible by cross matching. This means that antibody titer diminishes with time, and that posttransfusion screening tests should minimize the unexpected hazards of incompatible blood transfusion. We recommend that antibody screening tests should be routinely performed after open heart surgery, to minimize the risk of hemolysis during future reoperation.