Posttransfusional Hemolysis in Recipients of Glucose-6-Phosphate Dehydrogenase-Deficient Erythrocytes

Abstract

To test the hypothesis that transfusion of blood donated by individuals with glucose-6-phosphate dehydrogenease (G6PD) deficiency may result in a hemolytic reaction, we conducted a prospective longitudinal study in which 10 patients transfused with 1 unit of G6PD-deficient and 1 unit of normal red blood cells (RBC) were compared with 10 patients transfused with 2 units of age-matched normal RBC. We found that 24h after transfusion serum bilirubin (µmol/l) in the recipients of G6PD-deficient RBC was significantly higher than in the recipients of normal RBC (36±14 vs. 18±5, respectively, p>0.004). A parallel increase was found in the serum lactate dehydrogenase (LDH; IU/l) between the two groups (378±151 vs. 264±56, p<0.001). The difference in serum bilirubin (26±10 vs. 15±5, p<0.03) was still noted 48 h after transfusion, with only a marginal difference (p<0.08) in LDH. We conclude that an immediate posttransfusional hemolytic reaction can occur in recipients of G6PD- deficient RBC and therefore suggest that the differential diagnosis of posttransfusional hemolysis, particularly in populations where G6PD deficiency is prevalent, includes transfusion of erythrocytes from G6PD-deficient donors.

Glucose‐6‐phosphate dehydrogenase deficiency in transfusion medicine: the unknown risks

“…In several case reports, patients experienced unexplained haemolysis after RBC transfusion. Following investigation, the most likely cause of haemolysis was the transfusion of blood from G6PD‐deficient donors . In the most dramatic case, a patient who was simultaneously being treated for leprosy with dapsone, experienced profound haemolysis leading to organ failure and death .…”

“…Glucose‐6‐phosphate dehydrogenase (G6PD)‐deficient RBCs also respond less well to oxidative stress induced by refrigerated storage , with decreased recovery in vivo after transfusion . Several case reports describe haemolysis in vivo following transfusion of G6PD‐deficient RBCs , thereby raising the question of whether it is safe to transfuse RBCs from G6PD‐deficient donors. However, information regarding possible adverse effects of transfusing G6PD‐deficient RBCs remains limited.…”

Hemolytic Transfusion Reactions

“…53 Transfusion administered with hypotonic solutions or some drugs may also cause hemolysis. 57 Establishing the diagnosis of HTR may be particularly diffi cult in patients with liver disease, autoimmune hemolytic anemia, sickle cell anemia, or active bleeding. 55 In general, patients tolerate the infusion of hemolyzed blood remarkable well.…”

Safety of hematopoietic stem cell donation in glucose 6 phosphate dehydrogenase-deficient donors

“…Conflicting results have been reported on post-transfusion hemolytic risk in the recipient of a G6PD-deficient donor's blood. 12,13 Recently, the Italian BM donor registry, answering an approval query for PBSC donation from a G6PD-deficient candidate match for an unrelated donor, disseminated a warning about this condition. The warning, and the refusal to use this donor, was prompted by the absence of safety data (particularly regarding use of G-CSF) in this group of volunteer donors.…”