The safety of kidd-incompatible blood transfusion in a restricted setting: a case report

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)