Etablissement Français du Sang, Créteil, 94000, France.
Institut Mondor de Recherche Biomédicale, lnserm U955, Equipe 2, Créteil, 94000, France.
Am J Hematol. 2017 Dec;92(12):1340-1348. doi: 10.1002/ajh.24908. Epub 2017 Oct 31.
Delayed hemolytic transfusion reaction (DHTR) is a life-threatening complication of transfusion in sickle cell disease (SCD). The frequency of DHTR is underestimated because its symptoms mimic those of vaso-occlusive crisis and antibodies (Abs) are often not detectable. No predictive factors for identifying patients likely to develop DHTR have yet been defined. We conducted a prospective single-center observational study over 30 months in adult sickle cell patients. We included 694 transfusion episodes (TEs) in 311 patients, divided into occasional TEs (OTEs: 360) and chronic transfusion program (CTEs: 334). During follow-up, 15 cases of DHTR were recorded, exclusively after OTEs. DHTR incidence was 4.2% per OTE (95% CI [2.6; 6.9]) and 6.8% per patient during the 30 months of the study (95% CI [4.2; 11.3]). We studied 11 additional DHTR cases, to construct a predictive score for DHTR. The DHTR mortality is high, 3 (11.5%) of the 26 DHTR patients died. The variables retained in the multivariate model were history of DHTR, number of units previously transfused and immunization status before transfusion. The resulting DHTR-predictive score had an area under the ROC curve of 0.850 [95% CI: 0.780-0.930], a negative-predictive value of 98.4% and a positive-predictive value of 50%. We report in our study population, for the first time, the incidence of DHTR, and, its occurrence exclusively in occasionally transfused patients. We also describe a simple score for predicting DHTR in patients undergoing occasional transfusion, to facilitate the management of blood transfusion in SCD patients.
迟发性溶血性输血反应（DHTR）是镰状细胞病（SCD）输血的一种危及生命的并发症。由于其症状类似于血管阻塞性危象，并且通常无法检测到抗体（Abs），因此 DHTR 的频率被低估了。尚未确定用于识别可能发生 DHTR 的患者的预测因素。我们在 30 个月的时间里进行了一项前瞻性单中心观察性研究，涉及成年 SCD 患者。我们纳入了 311 名患者的 694 次输血事件（TE），分为偶发性 TEs（OTEs：360）和慢性输血计划（CTEs：334）。在随访期间，记录了 15 例 DHTR 病例，仅在 OTE 后发生。DHTR 的发生率为每 OTE 4.2%（95%CI [2.6; 6.9]），在研究的 30 个月中，每患者 6.8%（95%CI [4.2; 11.3]）。我们研究了另外 11 例 DHTR 病例，以构建 DHTR 的预测评分。DHTR 的死亡率很高，26 例 DHTR 患者中有 3 例（11.5%）死亡。多变量模型中保留的变量包括 DHTR 病史、先前输注的单位数和输血前的免疫状况。由此产生的 DHTR 预测评分的 ROC 曲线下面积为 0.850[95%CI：0.780-0.930]，阴性预测值为 98.4%，阳性预测值为 50%。我们在研究人群中首次报告了 DHTR 的发生率，并且仅在偶尔输血的患者中发生。我们还描述了一种用于预测偶尔输血患者 DHTR 的简单评分，以方便 SCD 患者的输血管理。
