Delayed hemolytic transfusion reaction information
This page is currently under construction.
Medical condition
Delayed hemolytic transfusion reaction
Specialty
Hematology and immunology
Symptoms
Drop in hemoglobin level, fever, jaundice, or hemoglobinuria, as well as chills, abdominal pain, or back pain
Usual onset
Generally up to one month
Causes
Transfusion of mismatched blood types, reactivity of recipient's antibodies against donor's red blood cell proteins, or prior damage to red blood cells contained in transfusion products
Risk factors
Medical malpractice, inadequate compatibility testing for blood transfusions, and negligent handling of blood products
Diagnostic method
Antiglobulin test, also known as a Coombs test
Differential diagnosis
Acute hemolytic transfusion reaction
Transfusion-related acute lung injury
Febrile non-hemolytic transfusion reaction
Transfusion-associated graft versus host disease
Hyperhemolysis
A delayed hemolytic transfusion reaction (DHTR) is a type of adverse reaction to a blood transfusion.[1][2][3][4] DHTR is the later-onset manifestation of hemolytic transfusion reaction, which may also present as acute hemolytic transfusion reaction (AHTR) in a shorter timeframe from transfusion administration. The prevalence of AHTR has been estimated at 1 in 70,000 blood transfusions, whereas the prevalence of DHTR is thought to be underreported, although various studies estimate the prevalence of DHTR as between 1 in 800, to 1 in 11,000 transfusions.[1]
Hemolytic transfusion reactions are a possible complication from red blood cell transfusions. Hemolysis refers to the lysis (rupture) of red blood cells, and the resulting leakage of their contents. Hemolytic reactions may be immune or non-immune mediated. Immune-mediated hemolytic reactions, such as DHTR, represent a type of alloimmunity. Non-immune hemolysis may result from thermal, osmotic, or mechanical damage to red blood cells in transfusion products.
In immune-mediated DHTR, the transfusion recipient has antibodies that react with antigens on incompatible donor red blood cells,[5] prompting lysis of the red blood cells by the recipient's immune cells, such as macrophages. The severity of immune-mediated hemolytic reactions may vary based on the type and quantity of both the transfused red blood cell antigens and the recipient's antibodies against them, as well as the ability of the antibodies to activate complement or opsonization. Some recipients do not have significant pre-existing antibodies against transfused red blood cells, but then develop higher levels of such antibodies following immune stimulation by the transfused red blood cells.
While AHTR usually presents within the first 24 hours after transfusion, DHTR has the possibility to present up to 30 days later. Even though DHTR may have a lower chance of severe outcomes than AHTR, it can still be fatal or result in serious complications, and must be treated as an urgent medical issue.
^Noizat-Pirenne F, Bachir D, Chadebech P, et al. (December 2007). "Rituximab for prevention of delayed hemolytic transfusion reaction in sickle cell disease". Haematologica. 92 (12): e132–5. doi:10.3324/haematol.12074. PMID 18055978.
^Talano JA, Hillery CA, Gottschall JL, Baylerian DM, Scott JP (June 2003). "Delayed hemolytic transfusion reaction/hyperhemolysis syndrome in children with sickle cell disease". Pediatrics. 111 (6 Pt 1): e661–5. doi:10.1542/peds.111.6.e661. PMID 12777582.
^Elenga N, Mialou V, Kebaïli K, Galambrun C, Bertrand Y, Pondarre C (December 2008). "Severe neurologic complication after delayed hemolytic transfusion reaction in 2 children with sickle cell anemia: significant diagnosis and therapeutic challenges". J. Pediatr. Hematol. Oncol. 30 (12): 928–30. doi:10.1097/MPH.0b013e31818c9172. PMID 19131783.
^Daniels, Geoff (2013-02-20). Human Blood Groups (1 ed.). Wiley. doi:10.1002/9781118493595. ISBN 978-1-4443-3324-4.
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