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Anti-Fya-mediated delayed hemolytic transfusion reaction following emergency-release red blood cell transfusion: possible involvement of HLA-DRB1*04:03 in the Japanese population

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Abstract

A 43-year-old Japanese male, who had undergone open liver surgery for tumor resection, presented with decreased hemoglobin levels on Day 13 post-emergency-release transfusion of 16 units of Fy(a +) red blood cells. As the anemia was accompanied by increased lactate dehydrogenase, indirect bilirubin, and reticulocytes, as well as decreased haptoglobin, it was attributed to hemolysis. In the diagnostic workup for hemolytic reaction, the direct antiglobulin test result for IgG was positive and the antibody dissociated from the patient’s peripheral red blood cells was identified as anti-Fya (titer, 4). The hemolytic reaction was transient (approximately 10 days), of moderate severity, and did not result in any obvious organ damage. However, a single compatible red blood cell transfusion of 2 units was required on Day 17 after the causative transfusion. Notably, HLA typing revealed that the patient carried the HLA-DRB1*04:03 allele, which has been implicated in immunogenicity and induction of anti-Fya response in Caucasian populations. In summary, this is the first documented case of definitive anti-Fya-mediated delayed hemolytic transfusion reaction associated with HLA-DRB1*04:03 in the Japanese population.

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Acknowledgements

The authors thank Shoko Arakawa, Shota Oikawa, Yuto Sakamoto, Yume Tomiya, Shota Fujiki, Tomoki Yada, Takumi Negishi, and Hayato Kojima for their contributions to this work.

Funding

This work was supported in part by Grants-in-Aid from the Fujita Health University Research Grant Program (YM and SF) and by JSPS KAKENHI Grant Number 21K15655 (HM).

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Author notes

  1. Takahiro Matsuno and Hideaki Matsuura contributed equally to this work.

Authors and Affiliations

  1. Department of Blood Transfusion, Fujita Health University Hospital, 1–98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470–1192, Japan

    Takahiro Matsuno, Hideaki Matsuura, Ryoka Suzuki, Yukari Sugiura & Yasuo Miura

  2. Department of Molecular Laboratory Medicine, Fujita Health University School of Medical Sciences, 1–98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470–1192, Japan

    Hideaki Matsuura

  3. Department of Transfusion Medicine and Cell Therapy, Fujita Health University School of Medicine, 1–98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470–1192, Japan

    Sumie Fujii & Yasuo Miura

Authors
  1. Takahiro Matsuno
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  2. Hideaki Matsuura
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  3. Sumie Fujii
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  4. Ryoka Suzuki
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  5. Yukari Sugiura
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  6. Yasuo Miura
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Contributions

TM and YS: Conception and study design, collection of study materials, data collection, analysis and interpretation, and manuscript writing. HM: conception and study design, collection of study materials, data collection, analysis and interpretation, financial support, and manuscript writing. RS: collection of study materials, data collection, analysis and interpretation, and manuscript writing. SF and YM: conception and study design, data analysis and interpretation, financial support, and manuscript writing. All authors approved the final version of the manuscript and agreed to all aspects of the work.

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Correspondence to Yukari Sugiura or Yasuo Miura.

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Matsuno, T., Matsuura, H., Fujii, S. et al. Anti-Fya-mediated delayed hemolytic transfusion reaction following emergency-release red blood cell transfusion: possible involvement of HLA-DRB1*04:03 in the Japanese population. Int J Hematol 115, 440–445 (2022). https://doi.org/10.1007/s12185-021-03242-3

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  • DOI: https://doi.org/10.1007/s12185-021-03242-3

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