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