Hemolytic transfusion reaction after preoperative prophylactic blood transfusion for sickle cell disease in pregnancy.
BACKGROUND
Preoperative transfusions are frequently given to prevent morbidity in nonpregnant patients with sickle cell disease. We describe a case of a life-threatening delayed hemolytic transfusion reaction with hyperhemolysis syndrome in pregnancy.


METHODS
A multigravida with sickle cell disease underwent prophylactic blood transfusion before repeat cesarean delivery. Her immediate postpartum course was uneventful, but on postoperative day number 6 she presented in grave condition with what was thought initially to be an infection versus crisis. Delayed hemolytic transfusion reaction with hyperhemolysis was ultimately diagnosed.


CONCLUSIONS
In the gravida with sickle cell disease and known multiple red cell antibodies, blood transfusion may incur a higher risk for delayed transfusion reaction, hyperhemolysis syndrome, and possible death. Blood transfusion should be used cautiously in these patients.
Department of Gynecology and Obstetrics, and Division of Maternal Fetal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Christine L
CL
Proudfit
Emad
E
Atta
Nora M
NM
Doyle
D000743:Anemia, Hemolytic / Q000276:immunology* / Q000517:prevention & control*; D000755:Anemia, Sickle Cell / Q000150:complications / Q000628:therapy*; D001787:Blood Group Incompatibility / Q000209:etiology; D017604:Cesarean Section, Repeat; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000628:therapy*; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011300:Preoperative Care; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction