Usually, plasma alloantibodies are detectable at 47days after the transfusion and reach maximum activity between 10 and 15days after the transfusion. These reactions can occur acutely or in a delayed timeframe, while the sensitizing antibody may derive from the host or be passively acquired. Hematopoietic stem cell transplantation (HSCT) is a potentially curative and increasingly used treatment approach for different malignant and nonmalignant diseases, including entities associated with HA, such as chronic lymphocytic leukemia with autoimmune HA (AIHA), paroxysmal nocturnal hemoglobinuria, and sickle cell disease.1 HA can develop after HSCT; however, HSCT can still be considered for the treatment of severe, therapy-resistant AIHA. Since most patients receive more than one unit of red blood cell concentrate, the estimated incidence of delayed haemolytic transfusion reactions is from 1:854 to 1:524 per patient who has been transfused and is higher than per transfused unit [7]. Platelets in additive solutions contain less donor plasma and thus less isohemagglutinins, and should therefore be preferred to standard plasma-suspended platelets. Impaired renal function is observed in both intravascular and extravascular haemolytic transfusion reactions, although definitely more frequently in the case of intravascular. xwTS7PkhRH
H. However, this complication is rare and predominantly accompanies intravascular haemolysis, but in recipients who have received non-compliant blood in the ABO system, it occurs even in 25% of cases [1]. DAF regulates C3a-converting activity. The prevention of renal failure is aided by an early prevention of hypotension. Copyright 2023 American Society of Anesthesiologists. We can see youre on your way to BMJ Best Practice for, Do you want to go to BMJ Best Practice for, No, Id like to continue to BMJ Best Practice for, bleeding from mucous membranes, GI tract, or urinary tract, exfoliative dermatitis with mucocutaneous involvement, visual inspection of post-transfusion blood sample, repeat ABO testing on post-transfusion blood sample, Gram stain and culture of component and post-transfusion recipient samples. Pure red cell aplasia (PRCA) may develop in up to 30% of patients after major ABO-incompatible HSCT, because of persistence of recipient plasma cells producing anti-donor isohemagglutinins, thus blocking normal erythroid maturation.8,15 Delayed red cell engraftment and PRCA are more common in reduced intensity transplantation (RIC) where donor and recipient hematopoiesis coexist and in cord blood transplantation. In addition, tumour necrosis factor (TNF) and interleukin-1 (IL-1), released by phagocytes during haemolytic transfusion reaction may also contribute to hypotension and shock [32]. Primarily, calcineurin inhibitors and/or sirolimus should be reduced in dose or discontinued if alternative drugs for the prevention or treatment of GVHD can be administered (eg, steroids, mycophenolate mofetil).