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Multiple hemolytic transfusion reactions misinterpreted as severe vaso‐occlusive crisis in a patient with sickle cell disease
Author(s) -
Dean Christina L.,
Maier Cheryl L.,
Roback John D.,
Stowell Sean R.
Publication year - 2019
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.15010
Subject(s) - medicine , vaso occlusive crisis , hemolysis , disease , complication , hemolytic anemia , sickle cell anemia , anemia , transfusion therapy , blood transfusion , intensive care medicine , surgery , immunology
BACKGROUND Hemolytic transfusion reactions are a rare, yet serious complication of red blood cell (RBC) transfusion. Patients with sickle cell disease (SCD) are at an increased risk for such reactions, because they are prone to make alloantibodies against transfused RBCs, complicating this integral part of their disease management. These reactions may be missed, and the patient's state may be attributed to vaso‐occlusive crisis (VOC), with misguided therapy ensuing. CASE REPORT Herein, we report the clinical course of a patient with complex SCD with a delayed hemolytic transfusion reaction, followed by multiple acute hemolytic transfusion reactions mistaken for severe VOC. These reactions were diagnosed on retrospective review of the patient's clinical course in consult with the transfusion medicine service. Optimal immunosuppressive therapy ensued and resulted in the stabilization of the anemia and hemolysis laboratory values. Despite these efforts, the patient died 2 months after admission. CONCLUSION This case provides insight into some of the challenges of managing patients with SCD with multiple comorbidities. Hemolytic transfusion reactions can be difficult to diagnose and may be overlooked in patients with SCD with severe VOC.