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

Abstract

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.

Delayed hemolytic transfusion reaction in adult sickle‐cell disease: presentations, outcomes, and treatments of 99 referral center episodes

“…For example, the patient's inflammatory status may be important. 17,20 In this series, 49% of the patients were transfused because of vaso-occlusive complications, ie VOC or ACS, which might imply an underlying inflammatory state. In Vilder et al's series, almost all patients were transfused in an acute setting.…”

“…Also, DHTR immunohematological characteristics showed that the diagnosis cannot rely only on the post-transfusion screening test. 17 Indeed, for 38% of the episodes, patients did not produce new formed Abs and, for many others, the newly formed Abs detected were not classically considered harmful. As previously proposed, it is possible that, during some of these episodes, the Abs were evanescent or not found because of their rare specificity.…”

Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects

“…A small observational study on alloimmunised sickle cell patients with a history of severe DHTR has suggested that rituximab may potentially minimise the risk of further alloimmunisation and severe DHTR, but does not prevent haemolysis in all patients (Noizat-Pirenne et al, 2015). Informed consent should be obtained from the patient before rituximab is used (Win, 2013).…”

Fatal Delayed Hemolytic Transfusion Reaction and Hyperhemolysiswithout Detectable Alloantibodies or Autoantibodies in a Patient withSickle Cell Disease: A Case Report and Literature Review

“…DHTR in sickle cell patients is a well-known complication of transfusion, entailing a significant drop in Hb (>25%) 5 to 15 days after transfusion. It is often caused by a secondary immune response to an antigen on the donor's erythrocytes and leads to the destruction of transfused erythrocytes [3,9,13]. This complication has a reported incidence of 3% to 7% in transfused SCD patients, and 4% to 12% of DHTRs may be fatal [14].…”

“…In such cases, intravenous immunoglobulin (IVIG) and Erythropoietin (EPO) should be administered concurrently [7]. For severe cases, EPO-Eculizumab should be considered [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. In cases where additional transfusions are necessary, EPO-Rituximab may prove successful [3].…”