A fatal case of acute hemolytic transfusion reaction caused by anti-Wra: Case report and review of the literature

Abstract

The red blood cell (RBC) antigen Wra is a low-prevalence antigen first described in 1953 by Holman and assigned to the Diego system in 1995. Because of its low prevalence, Wra is usually absent on commercial screening RBCs and antibody identification panels. When Wr(a+) screening RBCs are available, the corresponding antibody, anti-Wra, is often found in sera from healthy individuals, patients, and pregnant women. Anti-Wra can cause both hemolytic transfusion reactions and hemolytic disease of the fetus and newborn. We describe a fatal acute hemolytic transfusion reaction caused by anti-Wra in a patient with no other RBC alloantibodies. Serologic investigation showed that one of the RBC units the patient received was Wr(a+).