A Case Report of Red Blood Cell Alloimmunization and Delayed Hemolytic Transfusion Reaction in a Patient with an Uncommon Phenotype in Sickle Cell Disease: Review of Diagnosis and Management.

IF 0.7 Q4 HEMATOLOGY
Case Reports in Hematology Pub Date : 2024-09-19 eCollection Date: 2024-01-01 DOI:10.1155/2024/9980747
Cassandra P Wang, Denise Malicki, Courtney D Thornburg, Sonya Martinez, Jennifer C Yu
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Abstract

A delayed hemolytic transfusion reaction (DHTR) is a potential complication for patients with sickle cell disease (SCD) who develop red blood cell (RBC) alloimmunization to foreign antigens from allogeneic transfusions, potentially resulting in life-threatening hemolytic anemia between 24 hours and 28 days after the transfusion. Guidelines have suggested obtaining an extended RBC antigen profile by genotyping in patients with SCD to provide increased accuracy for antigen matching. We present a pediatric patient with SCD and a rare RBC phenotype that was not identified by serology who developed DHTR after her second lifetime transfusion and highlight the potential advantages of molecular genotyping. She was successfully managed by transfusion with "least incompatible" packed RBCs and aggressive medical management per American Society of Hematology clinical guidelines. Molecular genotyping is advantageous over serologic phenotyping because it can provide additional antigen information, such as increased accuracy for C antigen determination and Fyb antigen matching. Having RBC genotyping results on file for patients with SCD can facilitate care in two ways-by preventing alloimmunization with potential hemolytic transfusion reaction and by responding rapidly to request rare donors when complicating antibodies arise.

镰状细胞病不常见表型患者的红细胞异体免疫和延迟性溶血性输血反应病例报告:诊断与处理回顾。
迟发性溶血性输血反应(DHTR)是镰状细胞病(SCD)患者的一种潜在并发症,患者会因异体输血引起的红细胞(RBC)对外来抗原产生异体免疫,从而可能在输血后 24 小时至 28 天内导致危及生命的溶血性贫血。指南建议通过对 SCD 患者进行基因分型来获得扩展的红细胞抗原谱,以提高抗原配对的准确性。我们介绍了一名患有 SCD 且血清学未发现罕见 RBC 表型的儿童患者,她在第二次输血后出现了 DHTR,并强调了分子基因分型的潜在优势。根据美国血液学会的临床指南,她通过输注 "最不相容 "的包装 RBC 和积极的药物治疗成功地得到了控制。分子基因分型比血清表型更有优势,因为它可以提供额外的抗原信息,如提高 C 抗原测定和 Fyb 抗原匹配的准确性。将 SCD 患者的红细胞基因分型结果存档可以从两个方面促进治疗--防止潜在溶血性输血反应的同种异体免疫,以及在出现复杂的抗体时快速响应稀有供体的请求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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自引率
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发文量
51
审稿时长
13 weeks
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