Immunoglobulin‐resistant delayed hemolytic transfusion reaction treated with rituximab in an adult sickle cell patient

Delmonte, L; Cantini, Maurizio; Olivieri, Oliviero; Franceschi, Lucia De

doi:10.1111/trf.12090

Cited by 14 publications

(13 citation statements)

References 5 publications

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“…Rituximab: More recently, rituximab has emerged as a third line agent in refractory episodes of DHTR (Delmonte et al, 2013;Noizat-Pirenne et al, 2015) or prophylactically in polyimmunized patients with previous DHTR (Noizat-Pirenne et al, 2007;Bachmeyer et al, 2010). Rituximab dosing schedules varied in the literature; we have used both lowdose (100 mg IV once per week for 4 weeks) and standarddose (375 mg/m 2 weekly 94).…”

Section: Directed Treatmentsmentioning

confidence: 99%

How we treat delayed haemolytic transfusion reactions in patients with sickle cell disease

Gardner

Hoppe²,

Mijović

et al. 2015

Br J Haematol

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SummaryTransfusion therapy is effective in the prevention and treatment of many complications of sickle cell disease (SCD). However, its benefits must be balanced against its risks, including delayed haemolytic transfusion reactions (DHTR). Not only is the relative rate of alloimmunization higher in patients with SCD than in other patient populations, but attendant risks associated with DHTR are even greater in SCD. Clinicians' awareness of DHTR events is poor because symptoms of DHTR mimic acute vaso-occlusive pain and immunohaematology findings are often negative. Transfusions delivered in the acute rather than elective setting appear to confer a higher risk of DHTR. Management of DHTR in SCD depends on the clinical severity, ranging from supportive care to immunosuppression, and optimization of erythropoiesis. DHTR must be considered in any recently transfused patient presenting with acute sickle cell pain. Meticulous documentation of transfusion and immunohaematology history is key. We anticipate an increase in DHTR events in SCD patients with the increasing use of red blood cell transfusion therapy.

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Section: Directed Treatmentsmentioning

confidence: 99%

How we treat delayed haemolytic transfusion reactions in patients with sickle cell disease

Gardner

Hoppe²,

Mijović

et al. 2015

Br J Haematol

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“…As the prediction and prevention of DHTRs in patients with SCD remains a significant clinical challenge, efforts to develop immunosuppressive therapy–based approaches to prevent and/or treat ongoing DHTRs has become a primary focus in the management of transfusion complications in patients with SCD. Several approaches directed at potentially preventing or reducing the consequences of alloantibody‐mediated RBC removal in the setting of an active DHTR or when a DHTR appears likely include steroid‐induced immune suppression and IVIG . In some reported cases, patients have demonstrated an improvement following treatment with either IVIG alone or in combination with corticosteroids; however, some patients required further immunosuppression before recovery .…”

Section: Discussionmentioning

confidence: 99%

“…Several approaches directed at potentially preventing or reducing the consequences of alloantibodymediated RBC removal in the setting of an active DHTR or when a DHTR appears likely include steroid-induced immune suppression and IVIG. 4,[14][15][16][17][18][19][20] In some reported cases, patients have demonstrated an improvement following treatment with either IVIG alone or in combination with corticosteroids; however, some patients required further immunosuppression before recovery. 4,18,20,21 Rituximab, a chimeric mouse-human monoclonal antibody, reduces circulating CD20+ B cells in the peripheral blood and has been successfully used in the treatment of autoimmune hemolytic anemia.…”

Section: Discussionmentioning

confidence: 99%

“…4,[14][15][16][17][18][19][20] In some reported cases, patients have demonstrated an improvement following treatment with either IVIG alone or in combination with corticosteroids; however, some patients required further immunosuppression before recovery. 4,18,20,21 Rituximab, a chimeric mouse-human monoclonal antibody, reduces circulating CD20+ B cells in the peripheral blood and has been successfully used in the treatment of autoimmune hemolytic anemia. 22,23 While rituximab would not be predicted to actively prevent the immediate consequences of alloantibody-allogeneic RBC interactions, it may prevent the formation of additional alloantibodies in the setting of an evolving DHTR.…”

Section: Discussionmentioning

confidence: 99%

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Challenges in the treatment and prevention of delayed hemolytic transfusion reactions with hyperhemolysis in sickle cell disease patients

et al. 2019

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BACKGROUND Delayed hemolytic transfusion reactions (DHTRs) are serious complications of RBC transfusion that can occur in previously alloimmunized patients. Patients who require episodic transfusions during heightened inflammatory states, such as patients with sickle cell disease (SCD), are particularly prone to alloimmunization and developing DHTRs with hyperhemolysis. While efforts to mitigate these hemolytic episodes via immunosuppressive drugs can be employed, the relative efficacy of various treatment options remains incompletely understood. CASE REPORTS In this study, we explored five patients with SCD and multiple RBC alloantibodies who received various forms of immunosuppressive therapy in an attempt to prevent or treat severe DHTRs. RESULTS The clinical course for these five patients provides insight into the difficulty of effectively treating and preventing DHTRs in patients with SCD with currently available immunosuppressive therapies. CONCLUSION Based on our experience, and the current literature, it is difficult to predict the potential impact of various immunosuppressive therapies when seeking to prevent or treat DHTRs. Future mechanistic studies are needed to identify the optimal treatment options for DHTRs in the presence or absence of distinct alloantibodies in patients with SCD.

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“…Only one DHTR case was associated with immunization, and in both cases, the outcome was eventually good. However, the role of rituximab is difficult to assess in these two cases because both patients received other treatments in combination with rituximab .…”

Section: Introductionmentioning

confidence: 99%

The use of rituximab to prevent severe delayed haemolytic transfusion reaction in immunized patients with sickle cell disease

et al. 2014

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These cases suggest that rituximab prevents at least occurrence of newly formed antibodies in high responders and minimizes the risk of severe DHTR. This study confirms that DHTR is complex in SCD and does not rely only on the classical antigens/antibodies conflict. Considering potentially serious adverse effect of rituximab, this treatment should be considered cautiously, and only when transfusion is absolutely necessary in patients with history of severe DHTR linked to immunization.

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Immunoglobulin‐resistant delayed hemolytic transfusion reaction treated with rituximab in an adult sickle cell patient

Cited by 14 publications

References 5 publications

How we treat delayed haemolytic transfusion reactions in patients with sickle cell disease

How we treat delayed haemolytic transfusion reactions in patients with sickle cell disease

Challenges in the treatment and prevention of delayed hemolytic transfusion reactions with hyperhemolysis in sickle cell disease patients

The use of rituximab to prevent severe delayed haemolytic transfusion reaction in immunized patients with sickle cell disease

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