ISSN 2997-1036
International Journal of Hematology | Vol. 4, No. 1, January 2013 | pp. 1–8
DOI: 10.46882/2013/IJH/000037
Case Report
Title: Delayed hemolytic transfusion reaction mimicking a vaso-occlusive crisis in a patient with sickle cell anemia
Names of Authors: K. L. Musa¹, M. N. Lawal², O. P. Dikko³
Authors’ Affiliations: ¹Department of Haematology, Federal Medical Centre, Katsina, Nigeria; ²Department of Medicine, Bayero University, Kano, Nigeria; ³Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Abstract: Delayed hemolytic transfusion reactions are underdiagnosed complications in sickle cell anemia that can mimic acute vaso-occlusive crises and lead to severe hyperhemolysis. We report a 26-year-old female with sickle cell anemia (HbSS) who received 2 units of packed red blood cells for severe symptomatic anemia. Ten days post-transfusion, she presented with generalized bone pain, dark urine, and a rapid drop in hemoglobin from 9.5 g/dl to 4.1 g/dl. This drop fell below her baseline value of 6.8 g/dl, confirming a hyperhemolytic state. Total serum bilirubin rose to 6.2 mg/dl, and lactate dehydrogenase reached 1450 U/L. A repeat direct antiglobulin test was strongly positive (IgG and C3d), and an antibody eluate assay identified anti-Fya alloantibodies that were undetectable during pre-transfusion testing. Intravenous methylprednisolone (1 g daily for 3 days) and high-dose intravenous immunoglobulin (1 g/kg for 2 days) were initiated immediately. Hemolysis stabilized, reticulocytosis returned, and hemoglobin rose to 7.0 g/dl without further transfusions. This case highlights the need to consider delayed hemolytic reactions in patients presenting with severe pain and an unexplained drop in hemoglobin within two weeks of a transfusion.
Keywords: Sickle cell anemia, delayed hemolytic transfusion reaction, hyperhemolysis, alloantibodies, intravenous immunoglobulin
Manuscript Timeline: Received: October 18, 2012; Revised: November 24, 2012; Accepted: December 15, 2012; Published: January 18, 2013