{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:10:16Z","timestamp":1789017016143,"version":"build-2803163510"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Non-ABO alloantibody-mediated acute hemolytic transfusion reactions are infrequent but life-threatening complications of red blood cell transfusion. Anti-Jk\n                    <jats:sup>b<\/jats:sup>\n                    antibodies are difficult to detect in routine pretransfusion screening due to their low titers, weak avidity, and transient persistence. Here, we report a 16-month-old patient with \u03b2-thalassemia major who developed AHTR following transfusion of Jk\n                    <jats:sup>b<\/jats:sup>\n                    -positive RBCs. The patient had received two prior transfusions without documented adverse reactions. However, following the third transfusion, the patient developed acute intravascular hemolysis within two hours, manifesting as tea-colored urine, fever (39.2\u00a0\u00b0C), and marked hyperbilirubinemia (total bilirubin 173.7 \u03bcmol\/L). Hemoglobin declined from 62 g\/L to 28 g\/L over three days. Serologic workup revealed a positive direct antiglobulin test (1+), and antibody screening showed weak agglutination. Serologic workup confirmed the presence of anti-Jk\n                    <jats:sup>b<\/jats:sup>\n                    antibody. Further SCL14A1 genetic testing confirmed the absence of Jk\n                    <jats:sup>b<\/jats:sup>\n                    gene expression, and the patient\u2019s Kidd phenotype was determined as Jk (a+wb-). Subsequent transfusion of Jk\n                    <jats:sup>b<\/jats:sup>\n                    -negative, antigen-matched RBCs caused no hemolytic manifestations, and follow-up revealed that the patient\u2019s hemoglobin remained stable at approximately 90g\/L following red blood cell transfusion. This case highlights the diagnostic challenges associated with anti-Jk\n                    <jats:sup>b<\/jats:sup>\n                    alloantibodies and illustrates the clinical features of an anamnestic alloimmune response. These findings underscore the importance of rigorous antibody screening and antigen-matched transfusion in chronically transfused patients with thalassemia.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1899658","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:32:51Z","timestamp":1789014771000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute hemolytic transfusion reaction mediated by anti-Jkb antibody in a pediatric patient with \u03b2-thalassemia major: a case report illustrating an anamnestic alloimmune response"],"prefix":"10.3389","volume":"17","author":[{"given":"Jingyuan","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital","place":["Chengdu, China"]},{"name":"Department of Transfusion Medicine, West China Second University Hospital","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, West China Second University Hospital","place":["Chengdu, China"]},{"name":"Department of Transfusion Medicine, West China Second University Hospital","place":["Chengdu, China"]},{"name":"Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cll.2021.07.009","article-title":"Transfusion reactions and adverse events","volume":"41","author":"Abdallah","year":"2021","journal-title":"Clin Lab Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(15)01313-6","article-title":"Transfusion reactions: prevention, diagnosis, and treatment","volume":"388","author":"Delaney","year":"2016","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2016.10.003","article-title":"The Kidd (JK) blood group system","volume":"31","author":"Lawicki","year":"2017","journal-title":"Transfus Med Rev"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2003.18.6.894","article-title":"Acute hemolytic transfusion reactions due to multiple alloantibodies including anti-E, anti-c and anti-Jkb","volume":"18","author":"Park","year":"2003","journal-title":"J Korean Med Sci"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.70696","article-title":"Hemolytic transfusion reaction due to anti Jk antibody, a frequently transient and low-titer antibody probably not detected in pretransfusion testing; a case report","volume":"13","author":"Salarvand","year":"2025","journal-title":"Clin Case Rep"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.12413","article-title":"Italian Society of Hematology practice guidelines for the management of iron overload in thalassemia major and related disorders","volume":"93","author":"Angelucci","year":"2008","journal-title":"Haematologica"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16405","article-title":"Position paper on International Collaboration for Transfusion Medicine (ICTM) Guideline 'Red blood cell specifications for patients with hemoglobinopathies: a systematic review and guideline'","volume":"189","author":"Trompeter","year":"2020"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.61948","article-title":"Anti-Jk-b antibodies and hemolytic disease of the fetus and newborn: case-based learning","volume":"16","author":"R","year":"2024","journal-title":"Cureus"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1002\/eji.202250085","article-title":"Memory B-cell diversity: from early generation to tissue residency and reactivation","volume":"53","author":"Reusch","year":"2023","journal-title":"Eur J Immunol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2478\/immunohematology-2025-018","article-title":"Evanescence and persistence of red blood cell antibodies over time: a single-center experience","volume":"41","author":"Bogdanic","year":"2025"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.2450\/2008.0021-08","article-title":"The persistence of red cell alloantibodies","volume":"6","author":"Reverberi","year":"2008"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1802338","article-title":"Hemolytic transfusion reactions","volume":"381","author":"Panch","year":"2019","journal-title":"N Engl J Med"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/eji.202250085","article-title":"Memory B-cell diversity: from early generation to tissue residency and reactivation","volume":"53","author":"Reusch","year":"2023"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.tracli.2023.02.001","article-title":"Red blood cell alloimmunizations in thalassaemia patients with regular transfusion in China: a systematic review and meta-analysis","volume":"30","author":"Zhang","year":"2023","journal-title":"Transfus Clin Biol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2005.04366.x","article-title":"HLA-DRB1 alleles and Jk(a) immunization","volume":"45","author":"Reviron","year":"2005"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/labmed\/lmac104","article-title":"A rare case of hemolytic transfusion reaction in a premature infant caused by a passive anti-Jka antibody","volume":"54","author":"Yang","year":"2023"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.2639-23","article-title":"Clinical utility of flow cytometry for detection of anti-Jk(b) IgM in acute haemolytic transfusion reaction","volume":"63","author":"Nagaharu","year":"2024","journal-title":"Intern Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/hem3.70095","article-title":"TIF guidelines for the management of transfusion-dependent \u03b2-thalassemia","volume":"9","author":"Musallam","year":"2025"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1899658\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:32:59Z","timestamp":1789014779000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1899658\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":18,"alternative-id":["10.3389\/fimmu.2026.1899658"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1899658","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"1899658"}}