Fatal acute haemolytic transfusion reaction due to anti-B from a platelet apheresis unit stored in platelet additive solution

Background: Haemolytic transfusion reactions from out-of-group plasma in platelet (PLT) transfusions are uncommon. with most involving passive transfer of anti-A. only rare reactions have ever been reported due to anti-B.

Study Design and Methods: An apheresis PLT product was donate by a blood group O male, processed using PLT additive solution, and pathogen reduced. Postreaction receipt testing included an antibody screen using gel technology, a direct antiglobulin test (DAT) using immunoglobulin G and C3 and an eluate against group O and group B cells. Postreaction donor testing included measuring anti-B titers in saline, with and without anti human globulin.

Results: A 60-year-old blood group B patient with relapsed acute myeloid leukaemia developed confusion, fever, and hypertension within hours after blood group O PLT transfusion. The posttransfusion reaction evaluation was remarkable for positive DAT3+ for C3; the eluate showed anti-B. Rapid extravascular haemolysis occurred, with a 50% decline in haemoglobin, a high lactate dehydrogenase, and high bilirubin. She was resuscitated with fluids, blood products, pressors and oxygen and died of asystole 60 hours later. The donor's anti-B titers were 128 by tube testing at immediate spin and 512 at the anti-human globulin phase. Notably, a group b patient at a different hospital received a split of the same apheresis unit with no reaction.

Conclusion: To our knowledge, this is the first fatality reported from passively transfused anti-B. The fact that one transfusion recipient died whereas another did not have any reported reaction highlights the potential importance of recipient variables in isohemagglutlnin-mediated haemolysis.