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ABO incompatibility
25%
37/150
Citrate toxicity
14%
21/150
Cytokines from donated blood
23%
35/150
Dilutional pancytopenia
9%
14/150
Duffy incompatibility
28%
42/150
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This patient is presenting with jaundice and indirect bilirubinemia several days after a red blood cell transfusion with a smaller than expected increase in hemoglobin after transfusion. Incompatibilities of minor blood groups, such as the Duffy antigen, can result in delayed jaundice in an otherwise asymptomatic patient. Transfusion reactions occur with transfusion of any blood product. One of the most serious adverse reactions is an acute hemolytic reaction from ABO incompatibility. Patients can also have less severe hemolytic reactions due to minor blood group incompatibility. Examples of minor blood groups include Kell, Duffy, Kidd, and Lewis. If a donor has a blood antigen that the recipient is negative for, the recipient will form antibodies to that antigen, and hemolysis will occur. These patients present with delayed jaundice (several days after exposure), and the hemoglobin/hematocrit will not increase much (on average hemoglobin increases 1.0 g/dL per 1 unit of packed red blood cells). Patients will be otherwise asymptomatic. Incorrect Answers: Answer 1: ABO incompatibility would present with fevers, chills, back pain, and red/pink urine. Symptoms can occur within minutes of receiving a transfusion. It is due to antibodies the recipient forms against A or B blood group antigens. Answer 2: Citrate toxicity can occur with multiple transfusions. Citrate is an anticoagulant used in blood products. It chelates calcium and magnesium and can cause hypocalcemia and hypomagnesemia. This presents as paresthesias, cramping, and hyperreflexia. Answer 3: Cytokines from donated blood can result in a febrile non-hemolytic transfusion reaction. Patients will present with fever and chills 1-6 hours after transfusion. Answer 4: Dilutional pancytopenia can occur with multiple transfusions as these infusions can dilute blood cells through plasma expansion. This patient’s pancytopenia is more likely due to her recent chemotherapy. Additionally, dilutional pancytopenia would not explain the patient’s jaundice. Bullet Summary: Minor blood group incompatibility (e.g., Kell, Duffy, Lewis, or Kidd) presents with delayed jaundice and a minor increase in hemoglobin several days after exposure.
4.3
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