title: Transfusion-induced serum sickness.
abstract: BACKGROUND
  Transfusion-induced serum sickness reactions are rarely reported in the literature. The Type III hypersensitivity reaction to heterologous proteins involves deposition of complement and immune complexes in small vessel walls resulting in a leukocytoclastic vasculitis. A case of a multiply transfused patient with several episodes of serum sickness reactions is presented.
  
  
  METHODS
  A 61-year-old man with myelodysplastic syndrome type refractory anemia presented with fever, rash, and polyarthralgia 5 days after transfusion of red blood cells (RBCs). By transfusing plasma-free "washed" RBCs, similar serum sickness reactions were avoided.
  
  
  RESULTS
  Laboratory investigation showed an increase of serum creatinine, hematuria, and proteinuria. Levels of circulating immune complexes immunoglobulin G and immunoglobulin M were increased. Hypocomplementemia could not be demonstrated. Histopathologic examination of the skin showed leukocytoclastic vasculitis, compatible with serum sickness.
  
  
  CONCLUSIONS
  The importance of early recognition of transfusion-induced serum sickness reactions is emphasized, because this can reduce unnecessary morbidity from this unusual complication of transfusion. To prevent this type of transfusion reaction, patients who experienced serum sickness-like reactions after transfusion should only receive plasma-free washed RBCs.
authors.affiliation: Department of Laboratory Medicine, Imelda Hospital Bonheiden, Belgium.
authors.forename: Veroniek
authors.initials: V
authors.lastname: Saegeman
authors.forename: Wim
authors.initials: W
authors.lastname: Wynendaele
authors.forename: Stefan
authors.initials: S
authors.lastname: Kerre
authors.forename: Franceska
authors.initials: F
authors.lastname: Dedeurwaerdere
authors.forename: Marleen
authors.initials: M
authors.lastname: Van den Driessche
authors.forename: Jan
authors.initials: J
authors.lastname: Moerman
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D012713:Serum Sickness / Q000209:etiology / Q000276:immunology; D065227:Transfusion Reaction; D016896:Treatment Outcome; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000150:complications / Q000209:etiology / Q000276:immunology
chemical_list: D000893:Anti-Inflammatory Agents; D003404:Creatinine; D008775:Methylprednisolone