Treatment With Intravenous Immunoglobulin and Steroids May Correct Severe Anemia in Hyperhemolytic Transfusion Reactions: Case Report and Literature Review

Win, Nay; Sinha, Smita; Lee, Edmond; Mills, Wendy

doi:10.1016/j.tmrv.2009.09.006

Cited by 50 publications

(40 citation statements)

References 8 publications

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“…Previously described patients usually received corticosteroid therapy, 6,7,14 IVIg, 8 or both. 5,9,21 The protocol currently used at our institution involves IVIg infusion. However, no randomized controlled trials have been carried out to assess treatments for SCD patients with DHTR.…”

Section: Discussionmentioning

confidence: 99%

Delayed hemolytic transfusion reaction in children with sickle cell disease

Montalembert¹,

Dumont²,

Heilbronner³

et al. 2011

Haematologica

106

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Section: Discussionmentioning

confidence: 99%

Delayed hemolytic transfusion reaction in children with sickle cell disease

Montalembert¹,

Dumont²,

Heilbronner³

et al. 2011

Haematologica

106

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“…The first clinical signs appeared a median of 9.4 [IQR, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] …”

Section: Introductionmentioning

confidence: 99%

“…Because of the risk of increasing viscosity and VOC symptoms, few patients received IVIg or corticosteroids. 21,22 However, some authors found benefice to treat severe DHTR with IVIg/steroids, giving credit to a macrophage based destruction of RBCs in those cases. 9 Among the most recent DHTRs reported herein, 2 patients received anti-C5 eculizumab because of severe hyperhemolysis and 2 others with very severe symptoms received rituximab to avoid further immunization if a 2°TF were necessary.…”

mentioning

confidence: 99%

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

et al. 2016

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Delayed hemolytic transfusion reaction (DHTR) is one of the most feared complications of sickle-cell disease (SCD). We retrospectively analyzed the clinical and biological features, treatments and outcomes of 99 DHTRs occurring in 69 referral center patients over 12 years. The first clinical signs appeared a median of 9.4 [IQR, 3-22] days after the triggering transfusion (TT). The most frequent DHTR-related clinical manifestation was dark urine/hemoglobinuria (94%). Most patients (89%) had a painful vaso-occlusive crisis and 50% developed a secondary acute chest syndrome (ACS). The median [IQR] hemoglobin-concentration nadir was 5.5 [4.5-6.3] g/dL and LDH peak was 1335 [798-2086] IU/L. Overall mortality was 6%. None of the patients had been receiving chronic transfusions. Among these DHTRs, 61% were developed in previously immunized patients, 28% in patients with prior DHTR. Among Abs detected after the TT in 62% of the episodes, half are classically considered potentially harmful. No association could be established between clinical severity and immunohematological profile and/or the type and specificity of Abs detected after the TT. Management consisted of supportive care alone (53%) or with adjunctive measures (47%), including recombinant erythropoietin and sometimes rituximab and/or immunosuppressants. Additional transfusions were either ineffective or worsened hemolysis. In some cases, severe intravascular hemolysis can be likely responsible for the vascular reaction and high rates of ACS, pulmonary hypertension and (multi)organ failure. In conclusion, clinicians and patients must recognize early DHTR signs to avoid additional transfusions. For patients with a history of RBC immunization or DHTR, transfusion indications should be restricted. Am. J. Hematol. 91:989-994, 2016. © 2016 Wiley Periodicals, Inc.

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“…The analytical parameters that can be found are: a drop in Hb level below pretransfusion levels, reticulocytopenia, negative DAT in acute forms, abnormally high LDH and ferritin level,6 aggravated by subsequent transfusions. In urine, both Hb S and A can be detected by electrophoresis, although Hb A predominates 15. The main differential diagnosis is with a DTHR (see table 2).…”

Section: Discussionmentioning

confidence: 99%

When a transfusion in an emergency service is not really urgent: hyperhaemolysis syndrome in a child with sickle cell disease

Langeber¹,

Marco

Benedit

et al. 2018

BMJ Case Reports

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A 13-month-old boy with sickle cell disease (SCD) from Equatorial Guinea, who had recently arrived in Spain, presented with fever. He had suffered from malaria and had received a blood transfusion. Following physical examination and complementary tests, intravenous antibiotics and a red blood cell (RBC) transfusion were administered. Soon after a second transfusion 5 days later, the haemoglobin level fell below pretransfusion levels, together with reticulocytopenia, and haematuria-the so-called hyperhaemolysis syndrome-requiring intensive care and treatment with intravenous immunoglobulins and corticosteroids, with resolution of the complication. We want to emphasise the importance of suspecting this rare, though severe complication that can appear after any RBC transfusion especially in patients with SCD, as the clinical syndrome can simulate other more common complications of these patients and a further transfusion is contraindicated. There is no standardised treatment, but intravenous immunoglobulin and corticosteroids are usually effective.

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Treatment With Intravenous Immunoglobulin and Steroids May Correct Severe Anemia in Hyperhemolytic Transfusion Reactions: Case Report and Literature Review

Cited by 50 publications

References 8 publications

Delayed hemolytic transfusion reaction in children with sickle cell disease

Delayed hemolytic transfusion reaction in children with sickle cell disease

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

When a transfusion in an emergency service is not really urgent: hyperhaemolysis syndrome in a child with sickle cell disease

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