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Santos LA, de Almeida ACG, Tarragô AM, da Silva NRG, da Silva JNV, de Souza MM, Nascimento MOO, do Nascimento MR, Castro ACDS, de Albuquerque CX, Cardoso EC, Neto JPM, Albuquerque SRL. Investigation of Delayed Transfusion Reactions in Sickle Cell Disease Patients Polytransfused in the Brazilian Amazon. Hematol Rep 2024; 16:512-522. [PMID: 39189245 PMCID: PMC11348377 DOI: 10.3390/hematolrep16030049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) affects approximately 100,000 people in the United States and millions worldwide, with the highest prevalence of 70% of SCD being found in individuals of African ethnicity. Delayed hemolytic, alloimmunization, and anamnestic transfusion reactions in multiple transfusion patients need to be investigated and managed to avoid a worsening of the patient's clinical status. OBJECTIVE This paper aims to investigate delayed transfusion reactions in SCD patients who were polytransfused in the Brazilian Amazon. MATERIAL AND METHODS The clinical and laboratory indicators of SCD patients with more than four transfusions were investigated. The patients were treated at the Fundação Hospitalar de Hematologia e Hemoterapia do Estado do Amazonas, Brazil. RESULTS A total of 44 polytransfused patients with SCD were followed. Regarding Rh phenotype, it was possible to observe a frequency of 26.6% (12) patients with the RZRZ (DCE/DCE) phenotype, in addition to 4.5% (two) patients with RH and RHCE variants. It was also possible to observe 20.5% (nine) patients with an alloimmunization reaction, who presented the following alloantibodies: anti-RhD, anti-E, anti-K, anti-Jkb, anti-N, anti-S, and anti-Dia, two of which are unidentified. Of these, four (44.4%) patients also presented autoantibodies, anti-e, and three unidentified antibodies, and four (44.4%) patients presented an anamnestic reaction, with anti-RhD, K, and Jkb antibodies. Of the 44 patients monitored, 54.4% (24) had clinical and laboratory indicators of a delayed hemolytic reaction. CONCLUSION Delayed transfusion reactions, often neglected, occur frequently. Therefore, transfusions need to be monitored for at least 28 days, with medical investigation of clinical and laboratory indicators to make greater use of this therapeutic resource.
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Affiliation(s)
- Lorena Alves Santos
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia da Universidade do Estado do Amazonas (PPGH-UEA), Manaus 69050-001, AM, Brazil; (L.A.S.); (A.C.G.d.A.); (A.M.T.); (J.N.V.d.S.); (M.M.d.S.); (J.P.M.N.)
| | - Anne Cristine Gomes de Almeida
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia da Universidade do Estado do Amazonas (PPGH-UEA), Manaus 69050-001, AM, Brazil; (L.A.S.); (A.C.G.d.A.); (A.M.T.); (J.N.V.d.S.); (M.M.d.S.); (J.P.M.N.)
| | - Andrea Monteiro Tarragô
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia da Universidade do Estado do Amazonas (PPGH-UEA), Manaus 69050-001, AM, Brazil; (L.A.S.); (A.C.G.d.A.); (A.M.T.); (J.N.V.d.S.); (M.M.d.S.); (J.P.M.N.)
- Programa de Pós-Graduação em Imunologia Básica e Aplicada da Universidade Federal do Amazonas (PPGIBA-UFAM), Manaus 69067-005, AM, Brazil; (M.O.O.N.); (M.R.d.N.); (A.C.d.S.C.)
- Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil; (N.R.G.d.S.); (C.X.d.A.); (E.C.C.)
| | - Nina Rosa Gonçalves da Silva
- Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil; (N.R.G.d.S.); (C.X.d.A.); (E.C.C.)
| | - Juliana Nascimento Vitoriano da Silva
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia da Universidade do Estado do Amazonas (PPGH-UEA), Manaus 69050-001, AM, Brazil; (L.A.S.); (A.C.G.d.A.); (A.M.T.); (J.N.V.d.S.); (M.M.d.S.); (J.P.M.N.)
| | - Mônica Moura de Souza
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia da Universidade do Estado do Amazonas (PPGH-UEA), Manaus 69050-001, AM, Brazil; (L.A.S.); (A.C.G.d.A.); (A.M.T.); (J.N.V.d.S.); (M.M.d.S.); (J.P.M.N.)
| | - Monik Oney Oliveira Nascimento
- Programa de Pós-Graduação em Imunologia Básica e Aplicada da Universidade Federal do Amazonas (PPGIBA-UFAM), Manaus 69067-005, AM, Brazil; (M.O.O.N.); (M.R.d.N.); (A.C.d.S.C.)
| | - Marcelo Reis do Nascimento
- Programa de Pós-Graduação em Imunologia Básica e Aplicada da Universidade Federal do Amazonas (PPGIBA-UFAM), Manaus 69067-005, AM, Brazil; (M.O.O.N.); (M.R.d.N.); (A.C.d.S.C.)
- Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil; (N.R.G.d.S.); (C.X.d.A.); (E.C.C.)
| | - Ana Caroline dos Santos Castro
- Programa de Pós-Graduação em Imunologia Básica e Aplicada da Universidade Federal do Amazonas (PPGIBA-UFAM), Manaus 69067-005, AM, Brazil; (M.O.O.N.); (M.R.d.N.); (A.C.d.S.C.)
| | - Cinthia Xerez de Albuquerque
- Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil; (N.R.G.d.S.); (C.X.d.A.); (E.C.C.)
| | - Evilázio Cunha Cardoso
- Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil; (N.R.G.d.S.); (C.X.d.A.); (E.C.C.)
| | - José Pereira Moura Neto
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia da Universidade do Estado do Amazonas (PPGH-UEA), Manaus 69050-001, AM, Brazil; (L.A.S.); (A.C.G.d.A.); (A.M.T.); (J.N.V.d.S.); (M.M.d.S.); (J.P.M.N.)
- Universidade Federal de Juiz de Fora—Campus Governador Valadares, Governador Valadares 35032-620, MG, Brazil
| | - Sérgio Roberto Lopes Albuquerque
- Programa de Pós-Graduação em Ciências Aplicadas à Hematologia da Universidade do Estado do Amazonas (PPGH-UEA), Manaus 69050-001, AM, Brazil; (L.A.S.); (A.C.G.d.A.); (A.M.T.); (J.N.V.d.S.); (M.M.d.S.); (J.P.M.N.)
- Programa de Pós-Graduação em Imunologia Básica e Aplicada da Universidade Federal do Amazonas (PPGIBA-UFAM), Manaus 69067-005, AM, Brazil; (M.O.O.N.); (M.R.d.N.); (A.C.d.S.C.)
- Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus 69050-001, AM, Brazil; (N.R.G.d.S.); (C.X.d.A.); (E.C.C.)
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Omer SA, Alaesh JS, Algadeeb KB. Delayed Hemolytic Transfusion Reaction in a Patient with Sickle Cell Disease: Case Report. Int Med Case Rep J 2020; 13:307-311. [PMID: 32801941 PMCID: PMC7395695 DOI: 10.2147/imcrj.s257036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Blood transfusion is a key treatment of sickle cell disease (SCD) complications. Delayed hemolytic transfusion reaction (DHTR) is a delayed reaction, that occurs days to weeks following a transfusion, characterized by mild anemia and/or hyperbilirubinemia and is one of the serious complications of blood transfusion. The symptoms of DHTR resemble those of vaso-occlusive crisis secondary to SCD leading to difficulty or delaying in diagnosis of DHTR. DHTR may lead to multiple organ failure and death. Case Report A 31-year-old female patient with a known case of SCD presented to our ER in King Fahad hospital Hofuf in the Kingdom of Saudi Arabia, with a history of generalized body ache, exertional dyspnoea, headache and easy fatigability for a few days on a background history of episodic hospital admissions for SCD, but she was admitted 3 times over the previous 6 months and received 6 units of packed red blood cells (PRBCs). The last blood transfusion was 18 days earlier. She was sick and her Hb level was 4.5 g/dL with positive Coombs test and positive alloantibodies, diagnosed as DHTR. We treated her with prednisolone tablets 1 mg/kg daily, intravenous immunoglobulins, 0.4 gm/kg daily for 5 days, and rituximab 500 mg IV every week for 4 weeks. Her Hb level raised up to 8.2 g/dL and she was discharged in good condition. Conclusion Identifying risk factors for DHTR by history and presentation is urgently needed in order to risk stratify the transfusion regimen. It is important to avoid additional transfusions in these patients if possible because these may exacerbate the hemolysis and worsen the degree of anemia.
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Affiliation(s)
- Sawsan A Omer
- Department of Medicine, King Fahad Hospital Hofuf, Kingdom of Saudi Arabia (KFHH/KSA), Hofuf, Kingdom of Saudi Arabia.,Faculty of Medicine, University of Gezira, Wad Medani, Sudan
| | - Jafar S Alaesh
- Department of Medicine, King Fahad Hospital Hofuf, Kingdom of Saudi Arabia (KFHH/KSA), Hofuf, Kingdom of Saudi Arabia
| | - Kefah B Algadeeb
- Department of Medicine, King Fahad Hospital Hofuf, Kingdom of Saudi Arabia (KFHH/KSA), Hofuf, Kingdom of Saudi Arabia
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