Hemolytic transfusion reactions in sickle cell disease: underappreciated and potentially fatal

• Authors: Swee Lay Thein, National Institutes of Health; France Pirenne, Université Paris Est Créteil; Ross Fasano, Emory University; Anoosha Habibi, Laboratoire d’Excellence GR-Ex; Pablo Bartolucci, Henri-Mondor University Hospital; Satheesh Chonat, Emory University; Jeanne Hendrickson, Emory University; Sean Stowell, Emory University
• Journal Title: Haematologica
• Volume: Volume 105, Number 3
• Publisher: Ferrata Storti Foundation | 2020-03-01, Pages 539-544
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3324/haematol.2019.224709
• Subjects: Health Sciences, Immunology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Hematology; ACUTE LUNG INJURY; ALLOIMMUNIZATION; ANEMIA; ADULTS; PREVENTION; REDUCTION; RITUXIMAB; CHILDREN; THERAPY; SAFETY

Abstract

In conclusion, RBC alloantibodies and DHTR are not uncommon in patients with SCD. They are underappreciated and, in our opinion, are the single leading cause of transfusion-associated morbidity and mortality in this vulnerable population of patients. Many of the challenges associated with preventing and treating DTHR can be addressed by developing international and national RBC alloantibody databases, limiting RBC transfusions to situations that are evidence-based, implementing more accurate diagnostic strategies (through routine use of HbA quantification and standard antibody screening), better understanding the pathophysiology, and formally testing additional prophylactic and treatment approaches to prevent and treat these reactions. We urge our colleagues in hematology, transfusion medicine (from donor centers to transfusion services), laboratory information technology, funding agencies, and regulatory agencies to view RBC alloimmunization and DTHR in patients with SCD with a similar urgency as TRALI was viewed in past decades. Such a heightened awareness, and subsequent industry changes, are predicted to directly reduce the significant transfusion-associated complications that contribute to the current morbidity and mortality of patients with SCD.