title: A diagnostic nomogram for delayed hemolytic transfusion reaction in sickle cell disease.
abstract: Diagnosis of delayed hemolytic transfusion reactions (DHTR), one of the most dreaded complications of transfusion in patients with sickle cell disease (SCD), is challenging and not straightforward. Current diagnostic approaches are complex and not consensual; they are based on assessment of hemoglobin (Hb) drop and enhanced hemolysis, features also seen during classical vaso-occlusive events. In this observational study, we tested the hypothesis that the rate of decline in HbA after an index transfusion is a surrogate marker for the destruction of transfused RBC, which could be used diagnostically. We examined 421 transfusion episodes (in 128 patients of a French referral center for SCD) for which an Hb electrophoresis was obtained within 1 week following an index transfusion and repeated within 2 months (before a subsequent scheduled transfusion or during an acute complication). Chart review found DHTR to be present in 26 cases (6.2%), absent in 389 cases (92.4%), and possible in six cases (1.4%). As expected, DHTR was associated with accelerated hemolysis (increased serum bilirubin and lactic dehydrogenase concentrations) and a decline in total Hb as compared to the early post-transfusion value. However, the decline in HbA concentration appeared more effective in segregating between patients without DHTR and others. We propose a diagnostic nomogram for DHTR based on Hb A as a biologic marker of the survival of transfused RBCs. Am. J. Hematol. 91:1181-1184, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.|Université Paris Est Créteil, Faculté de Médecine, IMRB, Groupe de recherche CARMAS, Créteil, France.
authors.forename: Armand
authors.initials: A
authors.lastname: Mekontso Dessap
authors.affiliation: Établissement Français du sang (EFS) Île-de-France, Université Paris Est Créteil, Faculté de Médecine Créteil, France.|Laboratory of Excellence GRex, INSERM U955, Equipe 2, Créteil, France.
authors.forename: France
authors.initials: F
authors.lastname: Pirenne
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.|Université Paris Est Créteil, Faculté de Médecine, IMRB, Groupe de recherche CARMAS, Créteil, France.
authors.forename: Keyvan
authors.initials: K
authors.lastname: Razazi
authors.affiliation: Service de Biochimie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Moutereau
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.
authors.forename: Shariq
authors.initials: S
authors.lastname: Abid
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.|Université Paris Est Créteil, Faculté de Médecine, IMRB, Groupe de recherche CARMAS, Créteil, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, France.|Unité de Pneumologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Maitre
authors.affiliation: Service de Médecine Interne, AP-HP, Universitaires Henri Mondor, Créteil, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Michel
authors.affiliation: Laboratory of Excellence GRex, INSERM U955, Equipe 2, Créteil, France.|Unité des Maladies du Globule Rouge, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Galacteros
authors.affiliation: Laboratory of Excellence GRex, INSERM U955, Equipe 2, Créteil, France.|Unité des Maladies du Globule Rouge, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Pablo
authors.initials: P
authors.lastname: Bartolucci
authors.affiliation: Laboratory of Excellence GRex, INSERM U955, Equipe 2, Créteil, France.|Unité des Maladies du Globule Rouge, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
authors.forename: Anoosha
authors.initials: A
authors.lastname: Habibi
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D001663:Bilirubin / Q000097:blood; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D005602:France; D006441:Hemoglobin A / Q000032:analysis; D006461:Hemolysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D049451:Nomograms; D013997:Time Factors; D065227:Transfusion Reaction / Q000175:diagnosis* / Q000209:etiology
chemical_list: D006441:Hemoglobin A; D007770:L-Lactate Dehydrogenase; D001663:Bilirubin