Transfusion-induced serum sickness.
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.
Saegeman
Veroniek
V
Department of Laboratory Medicine, Imelda Hospital Bonheiden, Belgium.
Wynendaele
Wim
W
Kerre
Stefan
S
Dedeurwaerdere
Franceska
F
Van den Driessche
Marleen
M
Moerman
Jan
J
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
D000893:Anti-Inflammatory Agents; D003404:Creatinine; D008775:Methylprednisolone