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Acta chirurgica iugoslavica
2005, vol. 52, br. 3, str. 111-115
jezik rada: engleski
prikaz slučaja
doi:10.2298/ACI0503111V
Kasna hemolizna transfuziona reakcija uzrokovana anti-JKa antitelom
Vučelić D.a, Savić N.b, Đorđević R.c
aUniverzitet u Beogradu, Medicinski fakultet, Klinički centar Srbije
bInstitute for Cardiovascular Disease, Belgrade
cNational Blood Transfusion Institute of Serbia, Belgrade

Sažetak

Uvod: Kidd antitela su vrlo heterogena i teško se otkrivaju. Često su odgovorna za pojavu kasne transfuzione hemolizne reakcije (KTHR). Prikaz slučaja: Osoba ženskog pola, starosti 64 godine (trudnoća 6, porođaja 2, prekida trudnoće 4), sa negativnom transfuziološkom anamnezom, hospitalizovana zbog pneumonije i teške anemije. Na prijemu, vrednost hemoglobina (Hb) 63g/L i hematokrita (Ht) 0,21L/L. Zbog potrebe za transfundovanjem eritrocita, uzorak krvi je poslat u laboratoriju za serološko testiranje i pripremu krvi za transfuziju. Krvna grupa bolesnice ORh(D) + (poz). Direktan antihumanglobulinski test (DAT) i rutinski skrining antitela (ID-DiaCell I+II+III-P) negativni. Pripremljene su tri jedinice deplazmatisanih eritrocita sa negativnom interreakcijom (klasična metoda u epruveti). Bolesnica je primila dve jedinice eritrocita drugog , a treću trećeg dana, bez ispoljavanja nepovoljnih efekata. Vrednosti hematoloških parametara nakon primenjene tri jedinice iznosile su: Hb 116g/L i Ht 0,37L/L. Šestog dana dolazi do pojave subjektivno lošeg stanja sa osećajem malaksalosti, mučninom i blagom žuticom. Vrednosti Hb i Ht se snižavaju na 99g/L odnosno 0,33L/L sa tendencijom daljeg pada (sedmog dana Hb 83g/L, Ht 0,26L/L). Vrednosti ukupnog i direktnog bilirubina iznosile su 58,9umol/L (normalna vrednost 20,5umol/L i 14.9umol/l (normalna vrednost 7umol/L). Suspektovana je KTHR. ID-DiaMed gel tehnikom identifikovano je antitelo Jka specifičnosti sa ispoljenim fenomenom doze. Tipizacijom je utvrđeno da su sve tri transfundovane jedinice eritrocita Jka +, a fenotip eritrocita bolesnice Jk(a-b+). Bolesnica je primila dve jedinice tipiziranih Jka negativnih deplazmatisanih eritrocita i u dobrom opštem stanju otpuštena je četrnaestog dana. Zaključak: Pažljivo praćenje kliničkih efekata transfuzije i dobra saradnja sa specijalistima transfuzione medicine je od izuzetne važnosti u blagovremenom prepoznavanju transfuzionih reakcija. U transfuziološkoj praksi, pretransfuzioni uzorak se čuva tri nedelje, a interreakcija se izvodi sa uzorcima koji nisu stariji od 24 časa odnosno 48 časova.

Ključne reči

transfuzija eritrocita; Kidd krvno grupni sistem; komplement; odložena hemoliza

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