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Delayed hemolytic transfusion reactions. An often-missed entity.

D Solanki, P R McCurdy

    JAMA
    |February 20, 1978
    PubMed
    Summary

    Delayed hemolytic transfusion reactions can occur unexpectedly due to delayed antibody detection. Patients with prior sensitization need careful monitoring and identification to prevent future transfusion reactions.

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    Area of Science:

    • Hematology
    • Immunology
    • Transfusion Medicine

    Background:

    • Delayed hemolytic transfusion reactions (DHTRs) are a significant concern in transfusion medicine.
    • Understanding the kinetics of alloantibody detection is crucial for managing these reactions.

    Observation:

    • Eight patients experienced unexplained posttransfusion hematocrit drops, indicative of DHTRs.
    • Alloantibodies were detected in all patients, but often with a significant delay (up to 72 hours post-reaction).

    Findings:

    • Delayed detection of alloantibodies did not prevent subsequent acute hemolytic reactions.
    • Three patients developed reversible renal failure secondary to the hemolytic reactions.
    • Alloantibody detectability waned over time, with some becoming undetectable within months.

    Implications:

    • Patients with a history of RBC sensitization require meticulous record-keeping and identification (e.g., wristbands, cards).
    • Proactive measures are essential to mitigate risks associated with anamnestic antibody responses in transfused patients.
    • This highlights the importance of extended monitoring periods and robust patient identification systems in transfusion protocols.

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