Recurrent acute hemolytic transfusion reactions by antibodies against Doa antigens, not detected by cross-matching
Abstract
An 81-year-old male patient suffered from recurrent acute hemolytic transfusion reactions after transfusion with phenotyped cross-match-negative red blood cells (RBCs). Extensive posttransfusion workup eventually revealed Dombrock (a) (Doa) antibodies. Because commercially available cell panels do not allow for identification of anti-Doa and owing to the lack of Doa typing serum samples, selection of matched units of RBCs is dependent on negative cross-match results. In this case, selection of Do(a–) units by cross-matching failed, indicating that serologic methods were not reliable. A polymerase chain reaction with sequence-specific priming assay was used to detect DOA and DOB alleles, which encode Doa and Dob antigens, respectively. The patient was confirmed to be DOB/DOB by DNA sequencing. Furthermore, the involved mismatched units in each of the three hemolytic episodes were shown to be Do(a+). In the presenting case, DNA typing appeared to be superior to serologic methods in selecting matched RBC units in the presence of anti-Doa.
