An Unusual Case of Hyperhemolysis Syndrome and Delayed Hemolytic Transfusion Reaction due to Anti-Jk(a) and Anti-P1 Antibodies

Table 1

Laboratory values at initial presentation at our institution.

Complete metabolic panel	Range	Result
Sodium	136–144 mmol/L	135↓
Potassium	3.3–5.0 mmol/L
Chloride	102–110 mmol/L	106
Carbon dioxide	20–26 mmol/L	21
Blood urea nitrogen (BUN)	8–24 mg/dL	22
Creatinine	0.57–1.11 mg/dL	1.2↑
Glucose	64–128 mg/dL	189↑
Calcium	8.4–10.5 mg/dL	8.5
Protein, total	6.5–8.4 g/dL
Albumin	3.5–5.0 g/dL	3.2↓
Bilirubin, total	0.2–1.4 mg/dL	3.4↑
Alkaline phosphatase	38–126 U/L	44
Aspartate transaminase (AST)	16–40 U/L
Alanine transaminase (ALT)	5–60 U/L	41
Anion gap	8–14 mmol/L	8
Lactate dehydrogenase	100–253 U/L	4233↑
Magnesium	1.6–2.6 mg/dL	1.9
Phosphorus, inorganic	2.2–4.5 mg/dL	2.3
Procalcitonin	≤0.07 ng/mL	24.77↑
Uric acid	2.5–7.5 mg/dL	5.8
Complete blood count	Range	Result
White blood cells	4.30–11.30 k/uL	1.37↓
Red blood cells	4.08–5.47 M/uL	1.59↓
Hemoglobin	12.6–15.9 g/dL	5.5↓
Hematocrit	36.0–49.0%	16↓
Mean corpuscular volume (MCV)	81.9–101.0 fL	100.6
Mean corpuscular hemoglobin (MCH)	25.8–33.1 pg	34.6↑
Mean corpuscular hemoglobin concentration (MCHC)	31.2–34.5 g/dL	34.4
Red cell distribution width (RDW)	11.5–15.3%	19.1↑
Platelet	159–439 k/uL	10↓
Immature pit fraction	1.0–11.4%	19.5↑
Neutrophil count	2.0–7.4 k/uL	0.8↓
Reticulocyte number	47.0–127.0 k/uL	42↓
Reticulocytes (%)	1.0–2.6%	2.6
Total lymphocytes (%)	17–50%	30
Total neutrophil (%)	39–73%	57
Other studies	Range	Result
Iron	30–160 ug/dL	189↑
Iron-binding capacity	240–450 ug/dL	213↓
Transferrin saturation	20–50%sat	89↑
Bilirubin direct	0.0–0.5 mg/dL	0.5
Bilirubin, total	0.2–1.4 mg/dL	3.3
Ferritin	12–240 ng/mL	10,258↑
Folate, serum	≥5.9 ng/mL	>22.3
Haptoglobin	30–200 mg/dL	<10↓
Coagulation	Range	Result
Prothrombin time	12.0–15.5 sec	13.7
International normalized ratio (INR)	Ratio	1.1
Partial thromboplastin time (PTT)	24–35 sec	35
Fibrinogen	150–430 mg/dL	478↑
D-dimer	0.0–0.4 ug/mL	14.4↑
ADAMTS13 activity	≥61%	70

Unable to quantitate due to hemolysis of the sample. Bold values represent the abnormal values.