Delayed hemolytic transfusion reaction presenting as sickle-cell crisis

Area of Science:

• Hematology
• Transfusion Medicine
• Immunology

Background:

• Sickle-cell disease patients often require transfusions.
• Delayed hemolytic reactions (DHRs) are a known complication.
• Identifying risk factors for DHRs is crucial for patient safety.

Observation:

• Partial exchange transfusion was performed on 18 sickle-cell disease patients.
• Three patients experienced DHRs within six days post-transfusion.
• Two severe reactions were linked to anti-Jka antibodies, presenting with serum sickness-like symptoms.

Findings:

• DHRs in sickle-cell disease patients can present as severe painful crises.
• Antibodies to Kidd (Jka) antigen were associated with the most severe reactions.
• Patients with a history of alloantibody formation are at higher risk for DHRs.

Implications:

• DHRs may be underdiagnosed in sickle-cell disease patients.
• Suspect DHRs in patients with recurrent or severe sickle crises post-transfusion.
• Prioritize non-immunogenic blood products, especially for patients with known alloantibody production.