Two consecutive episodes of severe delayed hemolytic transfusion reaction in a sickle cell disease patient
Date
2020-04-15
Journal Title
Journal ISSN
Volume Title
Publisher
Hindawi
Abstract
Patients with sickle cell disease (SCD) suffer from anemia and painful vaso-occlusive crisis (VOC) and sometimes need blood
transfusions. Delayed hemolytic transfusion reaction (DHTR) is a rare life-threatening complication observed in SCD and mimics
VOC. We describe a female SCD patient undergoing three surgical procedures during which DHTR developed following the first
two. Prior to a planned tonsillectomy, she received transfusion and three days after surgery developed severe hemolysis as well as
pain and respiratory symptoms. On suspicion of VOC, she received additional transfusions and became hemodynamically
unstable, and her hemolytic anemia worsened. Gradually, she recovered and could be discharged after two weeks; DHTR was not
suspected. Sixteen months later, an arthroplasty was performed due to avascular necrosis, and again she was transfused preoperatively.
Similar to the initial surgery, she developed symptoms and signs of VOC after three days, but this time, DHTR was
suspected and further transfusions were withheld. Although immunosuppressive medication did not alleviate the condition, she
improved on combined treatment with darbepoietin, rituximab, and eculizumab. Six months later, a second arthroplasty was
performed uneventfully after prophylaxis with rituximab and without transfusion. DHTR should be considered in the presence of
severe, unexplained hemolysis following a recent transfusion, and additional transfusions in this setting should be given only on
vital indication.
Description
CITATION: Mpinganzima, C. et al. 2020. Two consecutive episodes of severe delayed hemolytic transfusion reaction in a sickle cell disease patient. Case Reports in Hematology, 2020:2765012, doi:10.1155/2020/2765012.
The original publication is available at https://www.hindawi.com/journals/crihem
The original publication is available at https://www.hindawi.com/journals/crihem
Keywords
Sickle cell anemia -- Patients, Blood -- Transfusion -- Complications, Hemolytic transfusion reaction
Citation
Mpinganzima, C. et al. 2020. Two consecutive episodes of severe delayed hemolytic transfusion reaction in a sickle cell disease patient. Case Reports in Hematology, 2020:2765012, doi:10.1155/2020/2765012.