Tocilizumab provides a potential therapeutic option for the management of hyperhaemolysis syndrome in sickle cell disease: A case series and brief narrative overview of the literature.

Abstract

Background and objectives: Hyperhaemolysis syndrome is a life-threatening complication of transfusion, potentially triggered by macrophage activation, with limited treatment options. Tocilizumab, an anti-IL6 monoclonal antibody, has mechanistic rationale for use and has been shown to be effective in a small number of cases. In this paper, we review four cases of hyperhaemolysis treated with tocilizumab in the context of the existing literature.

Materials and methods: Cases of use of tocilizumab in hyperhaemolysis were identified from two large specialist haemoglobinopathy centres between the period January 2021 and March 2025. Clinical and laboratory data were collected.

Results: Four cases of hyperhaemolysis treated with IVIG, steroids and tocilizumab were reported. In all cases, haemolysis responded rapidly to tocilizumab therapy. Two patients subsequently received RBC transfusions without haemolysis; two patients died from causes unrelated to haemolysis.

Conclusions: This case series supports the use of tocilizumab as a therapeutic option for rapid resolution of haemolysis. It is generally widely available and should be considered a suitable and cost-effective alternative to currently available options.