Antibodies to an HLA antigen can rarely cause an acute or delayed hemolytic transfusion reaction. Usually the presence of an HLA antibody is not associated with hemolysis. This should be suspected when other causes have been excluded.
Features of a hemolytic transfusion reaction associated with an HLA antibody:
(1) no red blood cell alloantibodies or autoantibodies that can explain the hemolytic reaction
(2) presence of HLA antibodies in the patient to HLA antigens in the donor of the hemolyzed products
(3) absence of hemolysis when transfused blood compatible for the HLA antibodies
When to suspected the presence of HLA antibodies:
(1) multiparous female
(2) patient who has received multiple transfusions
(3) presence of anti-Bg (Bennett-Goodspeed, target HLA antigens on RBCs)
Bg Antigen
HLA Antigen on RBCs
Bg-a
B7
Bg-b
B17
Bg-c
A28
A2
A10
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