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Delayed hemolytic transfusion reaction in children with sickle cell disease. Haematologica 2011 Jun;96(6):801-7

Date

02/19/2011

Pubmed ID

21330322

Pubmed Central ID

PMC3105640

DOI

10.3324/haematol.2010.038307

Scopus ID

2-s2.0-79958072849   72 Citations

Abstract

BACKGROUND: Transfusion is a cornerstone of the management of sickle cell disease but carries a high risk of hemolytic transfusion reaction, probably because of differences in erythrocyte antigens between blood donors of European descent and patients of African descent. Patients may experience hemolytic transfusion reactions that are delayed by from a few days to two weeks and manifest as acute hemolysis (hemoglobinuria, jaundice, and pallor), symptoms suggesting severe vaso-occlusive crisis (pain, fever, and acute chest syndrome), and profound anemia, often with reticulocytopenia. This case-series study aims to describe the main characteristics of this syndrome, to discuss its pathophysiology, and to propose a management strategy.

DESIGN AND METHODS: We identified 8 pediatric cases of delayed hemolytic transfusion reactions between 2006 and 2009 in the database of the Necker Hospital, France. All patients had received cross-matched red cell units compatible in the ABO, RH, and KEL systems. We reviewed the medical charts in the computerized blood transfusion databases. All patients were admitted to the intensive care unit. We progressively adopted the following strategy: intravenous immunoglobulins, and darbopoietin alpha when the reticulocyte count was below 150??10(9)/L, without further blood transfusion during the acute episode unless absolutely necessary.

RESULTS: The median time between the transfusion and the diagnosis of delayed hemolytic transfusion reaction was six days. All patients had severe bone pain; all but one had a high-grade fever. Five patients had hemoglobin levels less than than 4 g/dL and 3 had reticulocytopenia. In 5 patients, no new antibody was found; one patient had weakly reactive antibodies. Only 2 patients had new allo-antibodies possibly responsible for the delayed hemolytic reaction.

CONCLUSIONS: The initial symptoms of delayed hemolytic transfusion reaction were complex and mimicked other complications of sickle cell disease. In most of our cases, no new antibody was identified, which underlines the complexity of the pathophysiology of this syndrome.

Author List

de Montalembert M, Dumont MD, Heilbronner C, Brousse V, Charrara O, Pellegrino B, Piguet C, Soussan V, Noizat-Pirenne F

Author

Julie-An M. Talano MD Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Anemia, Sickle Cell
Child
Child, Preschool
Female
Hemolysis
Humans
Immunoglobulins, Intravenous
Isoantibodies
Male
Rh-Hr Blood-Group System
Transfusion Reaction
Treatment Outcome