A 68-year-old woman, whose only history of interest was iron deficiency anaemia studied by Gastroenterology since May 2013, with no history of nephrological problems. After progressive anaemia (haemoglobin 6.5g/dl), she was referred to hospital for transfusion of red blood cell concentrate, with a post-transfusion reaction and progressive deterioration of renal function, reaching maximum creatinine levels of 7.67mg/dl, urea 171mg/dl and oligoanuria. Admission to the Nephrology Department was decided, where a complete work-up was performed and haemoglobin values of up to 4.2mg/dl, LDH of 997IU/l, indirect bilirubin of 1.1mg/dl, reticulocytes 2.9%, haptoglobin of 36.40mg/dl and in the blood smear: anisopoikilocytosis with polychromasia were observed. A urine dipstick showed haematuria and pyuria. The data suggested intravascular haemolytic anaemia of autoimmune origin due to blood incompatibility.
The haematology department was consulted and reported the presence of irregular antibodies with anti-Tja specificity at a titre of 1/16. These results are compatible with the absence of an antigen of high incidence in the general population, the P antigen. During admission, renal function improved. He required several sessions of haemodialysis, supportive treatment with intense serum therapy and alkalinisation, and treatment for his anaemia with erythropoietin and intravenous iron, transfusion of four red blood cell concentrates. He currently has a creatinine of 0.3mg/dl and a haemoglobin of 10.6g/dl.