Accelerated immune red cell destruction in the absence of serologically detectable alloantibodies

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Abstract
Two patients are described in whom clinically significant red blood cell alloantibodies could be demonstrated only by in vivo 51Cr survival studies. The 1st patient had experienced a severe delayed hemolytic transfusion reaction to 4 units of crossmatch compatible blood. Serial phenotype studies suggested the presence of a serologically undetectable anti-c (hr'') antibody. 51Cr survival of c-positive red blood cells was 1% at 24 h; survival of c-negative red blood cells was 80% at 24 h. The 2nd patient had multiple red blood cell alloantibodies. An anti-c antibody was suspected but could not be convincingly demonstrated by in vitro techniques. 51Cr survival of c-positive red blood cells was 57% at 24 h and 17% at 48 h. 51Cr red blood cell survival studies should be considered whenever an unexplained hemolytic transfusion reaction occurs, or when an expected red blood cell alloantibody cannot be demonstrated by in vitro laboratory studies.