The complexities of transfusion reactions: Coexistence of a delayed haemolytic transfusion reaction and post‐transfusion purpura

Background and Objectives Immune‐mediated acute or delayed transfusion reactions occur when there is immunological incompatibility between transfused blood products and recipient's antibodies. Acute haemolytic transfusion reactions occur within 24 h and are delayed after 24 h up to 10 days following transfusion, whereas post‐transfusion purpura (PTP) typically occurs 7–10 days post‐transfusion. We present a case of a previously transfused and recently post‐partum female who developed both delayed haemolytic transfusion reaction (DHTR) and PTP. Case Report A 42‐year‐old woman, G2P1, with non‐alcoholic liver disease, portal hypertension and previous transfusion history with allogeneic anti‐E, developed a severe DHTR and PTP following a complicated post‐partum course and multiple transfusions. The antenatal and initial post‐partum pre‐transfusion antibody screens were negative. Subsequently five red cell antibodies, including anti‐c, anti‐Fya, anti‐Jkb and anti‐S and the reappearance of anti‐E were, however, identified during follow‐up investigations along with the anti‐platelet antibody HPA‐3a and human leukocyte antigen class I antibodies. Anti‐E, anti‐Jkb and anti‐S were eluted from the circulating red blood cells. Conclusion To our knowledge, there have been only two other case reports of DHTR and PTP occurring in the same patient.