Delayed haemolytic and serologic transfusion reactions: pathophysiology, treatment and prevention

Abstract

Delayed serologic and haemolytic reactions remain important and highly relevant transfusion-associated adverse events. Future directions include further unravelling the basic mechanisms, which underlie DHTRs and developing evidence-based approaches for treating these reactions. Implementing practical preventive strategies is also a priority.

TRIX with treats: the considerable safety benefits of a transfusion medicine registry

“…These factors contribute to DHTRs being a leading cause of transfusion‐associated fatality in the United States per FDA reports . Even if not fatal, anamnestic antibody responses can lead to severe morbidity via hyperhemolytic transfusion reactions, which are particularly dangerous and prevalent in SCD …”

“…The FDA reported 20 fatalities from non‐ABO antibodies over a 5‐year period with an annual transfusion volume of 11 million RBC units . In addition to the number of affected patients and their complications, the age and comorbidities of the recipient would also factor into a formal cost‐effectiveness analysis of a transfusion medicine registry, as nonfatal DHTRs can still be highly impactful clinically . Ultimately, it is likely that large numbers of moderate‐to‐severe DHTRs, and their associated comorbidities, could be prevented nationally with the implementation of a registry.…”

The evanescence and persistence of RBC alloantibodies in blood donors

“…Though most antibodies do not lead to adverse transfusion outcomes, some may substantially delay the provision of compatible RBC units, thereby impacting patient care. On occasion, acute and delayed hemolytic transfusion reactions occur despite antibody screening and crossmatch policies, due in part to previously formed RBC alloantibodies falling below the level of detection by transfusion services . This property, referred to as alloantibody evanescence, has been primarily studied in transfused patients, including patients with general disorders as well as those with chronic transfusion needs such as sickle cell disease .…”

“…On occasion, acute and delayed hemolytic transfusion reactions occur despite antibody screening and crossmatch policies, 2,3 due in part to previously formed RBC alloantibodies falling below the level of detection by transfusion services. 2,4 This property, referred to as alloantibody evanescence, has been primarily studied in transfused patients, including patients with general disorders as well as those with chronic transfusion needs such as sickle cell disease. 2,[4][5][6][7][8] In such groups, antibody disappearance rates have ranged from 30% to 80%, with testing over longer time periods being associated with a higher likelihood of the antibody falling below the level of detectability.…”

“…2,4 This property, referred to as alloantibody evanescence, has been primarily studied in transfused patients, including patients with general disorders as well as those with chronic transfusion needs such as sickle cell disease. 2,[4][5][6][7][8] In such groups, antibody disappearance rates have ranged from 30% to 80%, with testing over longer time periods being associated with a higher likelihood of the antibody falling below the level of detectability. 9 Although alloantibody evanescence rates have been established among patient populations, the rates of antibody evanescence in healthy allogeneic blood donors are not well established.…”