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Hereditary elliptocytosis of donor red blood cell unit detected during Coombs crossmatch

A red blood cell (RBC) unit was ordered for a patient with a negative antibody screen but a history of RBC alloantibodies, which requires Coombs crossmatch with microscopic evaluation at our institution if negative for macroscopic agglutination. Although the crossmatch was negative, the technologist astutely discerned numerous pencil-shaped RBCs during microscopic evaluation (Figure , light microscopy, 200× magnification). A peripheral blood smear prepared from a unit segment revealed approximately 50% elliptocytes (Figure inset, Wright-Giemsa stain, 400× magnification). The unit was quarantined and not issued to the patient. The donor was a healthy 22-year-old Asian woman and second-time whole blood donor, with a predonation hematocrit of 39%. Subsequently, the donor was deferred from future RBC donations. On follow-up, the