Anti-s antibody-associated delayed hemolytic transfusion reaction in patients with sickle cell anemia.
OBJECTIVE
Signs and symptoms of delayed hemolytic transfusion reaction (DHTR) may resemble those of vaso-occlusive crises in patients with sickle cell anemia (SCA). The diagnosis of DHTR therefore presents a challenge to the clinician when treating such patients. The current study describes a patient with SCA and DHTR secondary to red cell anti-s antibody, manifesting as painful extremeties, severe hemolytic anemia, and acute oliguric renal failure.


METHODS
A 17-year-old patient with homozygous hemoglobin S presented 8 days after partial exchange transfusions with severe anemia and signs and symptoms resembling vaso-occlusive crisis. Clinical course was complicated by intravascular hemolysis and acute renal failure.


RESULTS
Anti-s antibody was detected in the eluate. Diagnosis of DHTR was made. Treatment included single volume whole blood exchange transfusion and continuous veno-venous hemofiltration with dialysis.


CONCLUSIONS
The possibility of DHTR should be considered in a patient with SCA with hemolytic anemia. Acute renal failure is a rare complication of anti-s antibody-associated DHTR. Such reactions can be successfully managed with exchange transfusion and continuous hemofiltration with dialysis.
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit 48201, USA.
M
M
Kalyanaraman
S M
SM
Heidemann
A P
AP
Sarnaik
K L
KL
Meert
S A
SA
Sarnaik
D058186:Acute Kidney Injury / Q000209:etiology; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000276:immunology / Q000628:therapy*; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D006461:Hemolysis / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D013997:Time Factors; D065227:Transfusion Reaction
D001323:Autoantibodies; D007074:Immunoglobulin G