Prevention of delayed hemolytic transfusion reaction

Area of Science:

• Hematology
• Immunology
• Transfusion Medicine

Background:

• Post-transfusion hemolysis is the most common immune complication in sickle cell disease patients.
• Its incidence is frequently underestimated due to unique clinical and biological features.
• Alloimmunization against red blood cells (RBCs) is a primary driver, even when antibodies are undetectable.

Purpose of the Study:

• To highlight the underestimation of post-transfusion hemolysis in sickle cell disease.
• To discuss the role of alloimmunization and undetectable antibodies.
• To outline prevention strategies for transfusion reactions.

Main Methods:

• Review of clinical and biological characteristics of post-transfusion hemolysis.
• Analysis of alloimmunization incidence and antibody detection in sickle cell disease patients.
• Evaluation of transfusion history's impact on delayed hemolytic transfusion reactions (DHTR).

Main Results:

• Post-transfusion hemolysis is the most frequent immune reaction in sickle cell disease.
• In 30% of cases, no specific antibodies are detected despite hemolysis.
• Occasional transfusions carry a higher risk of DHTR compared to chronic transfusions.

Conclusions:

• Effective prevention requires addressing alloimmunization.
• Utilizing antigen-matched RBCs, especially for high-risk groups and considering transfusion history, is crucial.
• Immunotherapy may offer an additional strategy to prevent alloimmunization.