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Lim HJ, Jang H. The first case of hyperfibrinolysis induced by delayed hemolytic transfusion reaction in a trauma patient. Blood Transfus 2024; 22:34-36. [PMID: 37146301 PMCID: PMC10812894 DOI: 10.2450/bloodtransfus.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/02/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Ha Jin Lim
- Department of Laboratory Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Hyunseok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
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2
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Ni H, Sun X, Cong H. Analysis of Specificity and Distribution Characteristics of Red Blood Cell Irregular Antibodies. Lab Med 2023; 54:507-511. [PMID: 36810696 DOI: 10.1093/labmed/lmac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE The presence of red blood cell (RBC) irregular antibodies can severely jeopardize mother and child and bring trouble to the treatment of anemia. The aim of this study was to analyze the specificity of RBC irregular antibody in inpatients. METHODS An analysis was performed on samples from patients with RBC irregular antibodies. Antibody screening positive samples were analyzed. RESULTS Among the 778 cases of irregular antibody positive samples, 214 were from males and 564 from females. History of blood transfusion accounted for 13.1% of the total. Of the women, 96.8% had a pregnancy. A total of 131 antibodies were identified. The antibodies included 68 Rh systematic antibodies, 6 MNS systematic antibodies, 6 Lewis systematic antibodies, 2 Kidd systematic antibodies, 10 autoantibodies, and 39 antibodies of uncertain specificity. CONCLUSION Patients with blood transfusion or pregnancy history are prone to produce RBC irregular antibodies.
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Affiliation(s)
- Hui Ni
- Department of Blood Transfusion, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaoye Sun
- Department of Blood Transfusion, Affiliated Hospital of Nantong University, Nantong, China
| | - Hui Cong
- Department of Blood Transfusion, Affiliated Hospital of Nantong University, Nantong, China
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3
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Ferlis M, Lipato T, Roseff SD, Smith WR. Urgent use of voxelotor in sickle cell disease when immediate transfusion is not safe. Eur J Haematol 2022; 109:586-589. [PMID: 35848827 PMCID: PMC9804435 DOI: 10.1111/ejh.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023]
Abstract
The use of blood transfusions to improve anemia resulting from sickle cell disease (SCD) is often limited by alloimmunization, which occurs due to exposure to incompatible antigen present on donor red blood cells (RBCs). This complication occasionally manifests as delayed hemolytic transfusion reactions (DHTRs) that cause hemolysis of the recipient's own RBCs and can lead to fatal anemia. In this case study, we report a patient with SCD who experienced a DHTR following chronic transfusion and was successfully treated with voxelotor, an orally administered sickle hemoglobin (HbS) polymerization inhibitor for the treatment of SCD. Laboratory tests following admission indicated pan-reactivity in antigens, and a rare donor registry was used to locate acceptable units. The patient experienced the DHTR 3 days after admission, which limited laboratory tests due to profound hemolysis. Alternative treatments were limited, and phenotypically matched units were incompatible, so voxelotor was selected as a last-resort treatment. Following initiation of voxelotor 1500 mg, the patient's hemoglobin levels returned to baseline (6 g/dl) within 10 days, with clinical improvements. This report provides evidence regarding the use of voxelotor in the treatment of profound anemia where other treatments could be unsafe or unavailable.
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Affiliation(s)
- Mica Ferlis
- Division of General Internal MedicineVirginia Commonwealth University Medical CenterRichmondVirginiaUSA
| | - Thokozeni Lipato
- Division of General Internal MedicineVirginia Commonwealth University Medical CenterRichmondVirginiaUSA
| | - Susan D. Roseff
- Department of PathologyVirginia Commonwealth University Medical CenterRichmondVirginiaUSA
| | - Wally R. Smith
- Division of General Internal MedicineVirginia Commonwealth University Medical CenterRichmondVirginiaUSA
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4
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Rankin A, Webb J, Nickel RS. Preventing antibody positive delayed hemolytic transfusion reactions in sickle cell disease: Lessons learned from a case. Transfus Med 2022; 32:433-436. [PMID: 35318744 DOI: 10.1111/tme.12862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Red blood cell (RBC) transfusions are important in the management of patients with sickle cell disease (SCD). However, a potentially catastrophic complication of transfusion in this population is the delayed hemolytic transfusion reaction (DHTR). The pathophysiology of all DHTRs is not understood, but some are known to be caused by an anamnestic resurgence of RBC alloantibodies. CASE PRESENTATION A child with SCD transfused for acute chest syndrome re-presented a week after hospital discharge with severe anaemia, hemolysis, and a newly detected anti-E. This patient had been previously transfused years ago at an outside institution and the anti-E had not been previously documented. DISCUSSION The presented case of an antibody positive DHTR illustrates several concepts critical to the prevention of this complication. RBC alloantibodies must be detected and this information must be shared. Prophylactic C/c, E/e, K antigen matching is helpful for patients with SCD, but systems must be in place to identify these patients. Patients transfused at multiple different hospitals are especially at risk for this complication and efforts are needed to prevent them from suffering a DHTR.
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Affiliation(s)
- Alexander Rankin
- Children's National Hospital, Washington, District of Columbia, USA.,Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jennifer Webb
- Children's National Hospital, Washington, District of Columbia, USA.,The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
| | - Robert Sheppard Nickel
- Children's National Hospital, Washington, District of Columbia, USA.,The George Washington University School of Medicine & Health Sciences, Washington, District of Columbia, USA
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Gerritsma J, Bongaerts V, Eckhardt C, Heijboer H, Nur E, Biemond B, van der Schoot E, Fijnvandraat K. Extended phenotyping does not preclude the occurrence of delayed haemolytic transfusion reactions in sickle cell disease. Br J Haematol 2021; 196:769-776. [PMID: 34632580 DOI: 10.1111/bjh.17875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/12/2021] [Accepted: 07/30/2021] [Indexed: 01/29/2023]
Abstract
Delayed haemolytic transfusion reaction (DHTR) is a potentially life-threatening complication of red blood cell (RBC) transfusions in sickle cell disease (SCD) and is classically induced by reactivation of previously formed antibodies. Improved antigenic matching has reduced alloimmunization and may reduce DHTR risk. We conducted a retrospective cohort study to investigate the incidence rate of DHTR in SCD patients receiving extended matched units (ABO/RhDCcEe/K/Fya /Jkb /S). Occasional transfusion episodes (OTE) between 2011 and 2020 were reviewed for occurrence of DHTR symptoms using four screening criteria: decreased Hb, increased lactate dehydrogenase (LDH), pain, and dark urine. We included 205 patients who received a cumulative number of 580 transfusion episodes of 1866 RBC units. During follow-up, 10 DHTR events were observed. The incidence rate of DHTR was 13·8/1000 OTEs [95% confidence interval (CI): 7·37-22·2], with a cumulative incidence of 15·2% (95% CI: 8·4-24·0%) after 25 patients having received RBC units. One DHTR event was fatal (10%). Symptoms were misdiagnosed in four DHTR events (40%) as other acute SCD complications. Despite a lower incidence rate compared to most other studies, the incidence rate of DHTR in SCD remains high, in spite of extended matching of donor RBCs. Increased awareness of DHTR is of utmost importance to facilitate early diagnosis and, consequently, improve outcome.
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Affiliation(s)
- Jorn Gerritsma
- Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands.,Immunopathology, Sanquin Research and Landsteiner Laboratory, UMC, University of Amsterdam, Amsterdam, Amsterdam, the Netherlands
| | - Vera Bongaerts
- Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Corien Eckhardt
- Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Harriet Heijboer
- Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart Biemond
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen van der Schoot
- Immunohematology, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Karin Fijnvandraat
- Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands.,Molecular and Cellular Haemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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6
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Conrath S, Vantilcke V, Parisot M, Maire F, Selles P, Elenga N. Increased Prevalence of Alloimmunization in Sickle Cell Disease? Should We Restore Blood Donation in French Guiana? Front Med (Lausanne) 2021; 8:681549. [PMID: 34179050 PMCID: PMC8226117 DOI: 10.3389/fmed.2021.681549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022] Open
Abstract
Patients with sickle cell disease often undergo frequent blood transfusions. This increases their exposure to red blood cell alloantigens of donor units, thus making it more likely that they produce alloantibodies. This cross-sectional study aimed to describe the prevalence of allo-immunization in patients with sickle cell disease who were monitored at Cayenne Hospital in 2016. Of the 451 patients recruited during the study period, 238 (52.8%) were female. There were 262 (58.1%) homozygous sickle cell and 151 (33.5%) compound heterozygous sickle cell patients. The median age of the participants was 23.09 years (range, 0.5–68). We noted different red blood cell extended phenotypes: -in the Duffy system, the Fya- Fyb–profile was found in 299 patients (66%);—for the Kidd system, the most represented profile was Jka+ Jkb-, with 213 patients (47%). The Jka antigen was present in 355 patients;—in the MNS system, the S-s+ profile was found in 297 patients (66%);—the Lea antigen of the Lewis system was absent in 319 patients. The most frequent Rh phenotype in our patients was D+ C- E- c+ e+ K-, representing 51% of the patients. A total of 6,834 transfused packed red blood cell units were recorded. Sixty-eight patients (23%; 95% confidence interval, 20–25%) had detectable RBC alloantibodies. In multivariate logistic regression, only the mean number of single transfusions was statistically higher for the alloimmunized patients (p < 0.04). Thirteen (19%) of the patients with alloimmunization developed a delayed hemolytic transfusion reaction, thus representing 4.4% of the total number of transfused patients. Whether differences between donors from France vs. recipients from French Guiana could explain this high prevalence of alloimmunization to be examined. In conclusion, careful transfusion strategies for patients with RBC alloantibodies should allow further reduction of the rate of alloimmunization.
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Affiliation(s)
- Salomé Conrath
- Sickle Cell Disease Center, Andrée Rosemon Regional Hospital, Cayenne, French Guiana
| | - Vincent Vantilcke
- Sickle Cell Disease Center, Andrée Rosemon Regional Hospital, Cayenne, French Guiana
| | - Mickael Parisot
- Sickle Cell Disease Center, Andrée Rosemon Regional Hospital, Cayenne, French Guiana
| | - Françoise Maire
- Etablissement Français du Sang, Andrée Rosemon Regional Hospital, Cayenne, French Guiana
| | - Pierre Selles
- Etablissement Français du Sang, Andrée Rosemon Regional Hospital, Cayenne, French Guiana
| | - Narcisse Elenga
- Sickle Cell Disease Center, Andrée Rosemon Regional Hospital, Cayenne, French Guiana.,Pediatric Medicine and Surgery, Andrée Rosemon Regional Hospital, Cayenne, French Guiana
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Das S, Priyamvada PS, Basavarajegowda A, Mathur A. Deciphering a delayed hemolytic transfusion reactions nightmare - Case of Chido/Roger antibodies. Asian J Transfus Sci 2020; 13:132-135. [PMID: 31896921 PMCID: PMC6910026 DOI: 10.4103/ajts.ajts_152_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 11/19/2018] [Indexed: 11/04/2022] Open
Abstract
Antibodies against Rh (CEce) and Kidd (Jka and Jkb) system antigens are mostly implicated in delayed hemolytic transfusion reactions (DHTR), which is a potentially life-threatening complication observed in patients receiving chronic transfusions. Here, we are describing a case of Chido/Roger antibody which presented to our laboratory as DHTR. The clinical presentation and laboratory findings including the immunohematological workups with regard to the reaction are discussed, with a special emphasis on the benefit of identifying such an antibody and obtaining blood unit for transfusion supports the patient with respect to providing a compatible unit.
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Affiliation(s)
- Soumya Das
- Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - P S Priyamvada
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Abhishekh Basavarajegowda
- Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ankit Mathur
- Department of Transfusion Medicine, Bangalore Medical Services Trust, Rotary Bangalore TTK Blood Bank, Bengaluru, Karnataka, India
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Ipe TS, Wilkes JJ, Hartung HD, Westhoff CM, Chou ST, Friedman DF. Severe hemolytic transfusion reaction due to anti-D in a D+ patient with sickle cell disease. J Pediatr Hematol Oncol 2015; 37:e135-7. [PMID: 25171447 DOI: 10.1097/MPH.0000000000000241] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 5-year-old male with sickle cell disease presented with pain, dark urine, and fatigue 10 days after a red blood cell (RBC) transfusion. Laboratory evaluation demonstrated severe anemia, blood type O+, and anti-D in the serum. Anti-D in a D+ patient led to RH genotyping, which revealed homozygosity for RHD*DAU4 that encodes partial D antigen. Anti-D in this patient whose RBCs exclusively express partial D caused a delayed hemolytic transfusion reaction after exposure to D+ RBCs. The finding of anti-D in a D+patient should be investigated by molecular methods to help distinguish an alloantibody from an autoantibody.
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Dolatkhah R, Esfahani A, Torabi SE, Kermani IA, Sanaat Z, Ziaei JE, Nikanfar A, Chavoshi SH, Ghoreishi Z, Kermani AA. Delayed hemolytic transfusion reaction with multiple alloantibody (Anti S, N, K) and a monospecific autoanti-JK(b) in intermediate β-thalassemia patient in Tabriz. Asian J Transfus Sci 2013; 7:149-50. [PMID: 24014947 PMCID: PMC3757777 DOI: 10.4103/0973-6247.115580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
It appears that delayed hemolytic transfusion reactions may occur several days after the administration of donor red cells is true even though they have been shown to be compatible in cross match tests by the antiglobulin technique. A specific case was observed in our center, which confirms the fact. The patient was a 37-year-old male suffering from intermediate β-thalassemia. He had a history of two previous transfusions, with unknown transfusion reaction. In the last transfusion, laboratory data showed: Hb 7.8 g/dL and Hematocrit (Hct) 24.2%. The patient received two units of cross matched, compatible concentrated red blood cells (RBCs). After eight days a severe reaction was observed with clinical evidence of tachycardia, fatigue, fever, back pain, chest discomfort, jaundice, nausea and anorexia. Accordingly delayed hemolytic transfusion reaction was suspected, and anti-RBC antibodies were tested. Laboratory tests revealed the presence of three alloantibodies: Anti-N, anti-S, anti-K, and a monospecific autoanti-JK(b).
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Affiliation(s)
- Roya Dolatkhah
- Department of Hemophilia and Thalassemia, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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