Challenges in the treatment and prevention of delayed hemolytic transfusion reactions with hyperhemolysis in sickle cell disease patients
Christina L. Dean
Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorCheryl L. Maier
Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorSatheesh Chonat
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
Search for more papers by this authorAndres Chang
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
Search for more papers by this authorMarcus A. Carden
Department of Pediatrics and Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Search for more papers by this authorFuad El Rassi
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
Search for more papers by this authorMorgan L. McLemore
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
Search for more papers by this authorCorresponding Author
Sean R. Stowell
Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
Senior authors contributed equally.Address reprint requests to: Ross M. Fasano, MD, Center for Transfusion and Cellular Therapies, Emory University Hospital, Atlanta, GA 30322; e-mail: [email protected]; or Sean R. Stowell, MD, PhD, Center for Transfusion and Cellular Therapies, Emory University Hospital, Atlanta, GA 30322; e-mail: [email protected].Search for more papers by this authorCorresponding Author
Ross M. Fasano
Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
Senior authors contributed equally.Address reprint requests to: Ross M. Fasano, MD, Center for Transfusion and Cellular Therapies, Emory University Hospital, Atlanta, GA 30322; e-mail: [email protected]; or Sean R. Stowell, MD, PhD, Center for Transfusion and Cellular Therapies, Emory University Hospital, Atlanta, GA 30322; e-mail: [email protected].Search for more papers by this authorChristina L. Dean
Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorCheryl L. Maier
Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
Search for more papers by this authorSatheesh Chonat
Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
Search for more papers by this authorAndres Chang
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
Search for more papers by this authorMarcus A. Carden
Department of Pediatrics and Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Search for more papers by this authorFuad El Rassi
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
Search for more papers by this authorMorgan L. McLemore
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
Search for more papers by this authorCorresponding Author
Sean R. Stowell
Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
Senior authors contributed equally.Address reprint requests to: Ross M. Fasano, MD, Center for Transfusion and Cellular Therapies, Emory University Hospital, Atlanta, GA 30322; e-mail: [email protected]; or Sean R. Stowell, MD, PhD, Center for Transfusion and Cellular Therapies, Emory University Hospital, Atlanta, GA 30322; e-mail: [email protected].Search for more papers by this authorCorresponding Author
Ross M. Fasano
Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
Senior authors contributed equally.Address reprint requests to: Ross M. Fasano, MD, Center for Transfusion and Cellular Therapies, Emory University Hospital, Atlanta, GA 30322; e-mail: [email protected]; or Sean R. Stowell, MD, PhD, Center for Transfusion and Cellular Therapies, Emory University Hospital, Atlanta, GA 30322; e-mail: [email protected].Search for more papers by this authorAbstract
BACKGROUND
Delayed hemolytic transfusion reactions (DHTRs) are serious complications of RBC transfusion that can occur in previously alloimmunized patients. Patients who require episodic transfusions during heightened inflammatory states, such as patients with sickle cell disease (SCD), are particularly prone to alloimmunization and developing DHTRs with hyperhemolysis. While efforts to mitigate these hemolytic episodes via immunosuppressive drugs can be employed, the relative efficacy of various treatment options remains incompletely understood.
CASE REPORTS
In this study, we explored five patients with SCD and multiple RBC alloantibodies who received various forms of immunosuppressive therapy in an attempt to prevent or treat severe DHTRs.
RESULTS
The clinical course for these five patients provides insight into the difficulty of effectively treating and preventing DHTRs in patients with SCD with currently available immunosuppressive therapies.
CONCLUSION
Based on our experience, and the current literature, it is difficult to predict the potential impact of various immunosuppressive therapies when seeking to prevent or treat DHTRs. Future mechanistic studies are needed to identify the optimal treatment options for DHTRs in the presence or absence of distinct alloantibodies in patients with SCD.
CONFLICT OF INTEREST
The authors have disclosed no conflicts of interest.
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