The safety of kidd-incompatible blood transfusion in a restricted setting: a case report
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Transfusion reaction, incompatibility, Kidd blood group
Abstract
Latar belakang: Protein Kidd merupakan transporter urea pada sel darah merah. Walaupun jarang, adanya antibodi terhadap antigen ini dapat menyebabkan reaksi transfusi dan hemolytic disease of the newborn. Keberadaan anti-Jka dan anti-Jkb cukup jarang ditemukan pada pemeriksaan identifikasi antibodi pasien. Studi ini melaporkan kasus pasien dengan keberadaan anti-Jka and anti-Jkb, yang mendapat darah dengan kadar aglutinasi terendah pada kondisi dimana darah kompatibel sulit didapat sementara tindakan transfusi sangat dibutuhkan segera.
Penyajian Kasus: Wanita, 36 tahun, G4P3A0, datang dengan perdarahan vaginam sejak sebulan terakhir. Dari hasil pemeriksaan USG, didapatkan adanya mola hidatidosa. Pasien memerlukan terapi kuret segera setelah anemia terkoreksi (Hb 8.3 g/dL). Pada uji kecocokan pre-transfusi dengan prosedur skrining antibodi yang dilanjutkan dengan identifikasi antibodi, ditemukan anti-Jka dan anti-Jkb. Dari setidaknya 50 darah donor yang dilakukan uji kecocokan, tidak ditemukan darah yang kompatibel, sehingga pasien diputuskan untuk mendapat transfusi menggunakan darah inkompatibel dengan derajat aglutinasi terendah (level 2) dari 5 level, disertai dengan pemantauan ketat terhadap potensi terjadinya reaksi transfusi. Demam dan pruritus dilaporkan dalam 24 jam setelah transfusi, dan membaik setelah pemberian injeksi difenhidramin, deksametason, dan parasetamol.
Kesimpulan: Transfusi dengan darah yang inkompatibel merupakan pilihan terakhir bila tidak ditemukan darah donor yang kompatibel. Reaksi transfusi merupakan efek yang sulit dihindari, tetapi dapat dilakukan pemantuan ketat. Pemilihan darah dengan level aglutinansi terendah adalah keputusan terbaik, mengingat tindakan medis diperlukan segera untuk menyelamatkan nyawa. Pada kasus ini, pasien mendapat tatalaksana optimal dari aspek tindakan operasi dan respon transfusi, yang ditunjukkan melalui kenaikan nilai Hb yang bermakna. Sementara itu, efek samping reaksi transfusi yang muncul hanya ringan dan dapat ditanggulangi dengan pemberian obatobatan. (Health Science Journal of Indonesia 2019;10(2):137-9)
Kata kunci: reaksi transfusi, inkompatibilitas, kelompok darah Kidd
Abstract
Background: Kidd protein is red blood cell’s (RBC) major urea transporter. Albeit rare, the presence of antibodies against Kidd antigen may cause significant hemolytic transfusion reaction and hemolytic disease of the newborn. Yet, anti-Jka and anti-Jkb are rare to be discovered during antibody identification. This paper reported “bestmatched” transfusion practice in a patient with anti-Jka and anti-Jkb, where compatible PRC cannot be found, but transfusion is urgently needed.
Case Presentation: A 36 years old, G4P3A0 female, came with continuous vaginal bleeding for the past one month before admission. USG revealed hydatidiform mole. She needed immediate curettage following correction of her anemia (Hb 8.3g/dL). After antibody screening procedure followed by antibody identification, we found a positive anti-Jka and anti-Jkb in her blood sample. At least 50 blood donors were tested for compatibility and none was a match. She was then transfused with the lowest agglutination blood available (level 2 of 5 levels), with a closed monitoring to anticipate the possibility of transfusion reaction development. Fever and pruritus transpired within 24 hours post transfusion and it resolved following diphenhydramine, dexamethasone, and paracetamol injection.
Conclusion: Incompatible blood transfusion is the last option when compatible blood cannot be found. The development of transfusion reaction is inevitable, but it can be anticipated by closed monitoring. In restricted setting, blood transfusion with the lowest level of agglutination is acceptable when transfusion is imperative. In this case, the patient got optimal treatment in term of the medical surgery and transfusion response, which was shown by the significant increase of Hb level. Meanwhile, the adverse transfusion reaction was only mild, and could be treated with medicine. (Health Science Journal of Indonesia 2019;10(2):137-9)
Keywords: Transfusion reaction, incompatibility, Kidd blood group
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