A 57-year-old male underwent allogeneic bone marrow transplant for acute myeloid leukemia. Pre-transplant antibody screening was negative. The patient is A positive, while the donor is O positive. On post-transplant day 8, the hemoglobin dropped from 9.1 g/dL to 6. g/dL in 24 hours. After 2 units of packed red blood cells, the count remained low at 6.4 g/dL. In the following 4 days, the patient received 9 units of packed red cells (O neg) to maintain his hemoglobin level (see hemoglobin and bilirubin dynamics below). An imaging workup was negative for bleeding. An initial laboratory workup was significant for increased indirect bilirubin and LDH, decreased haptoglobin, and presence of hemoglobin in urine. The transfusion medicine work up showed a positive Direct Agglutination Test, group typing was A positive with mixed-field reaction, and the antibody screen is shown below.
Aleh (Oleg) Bobr, M.D.
Resident, Anatomic and Clinical Pathology
Eapen Jacob, M.D.
Consultant, Transfusion Medicine
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine