Saleh Mohammed, Mallipeddi Vishnu Priya, Ali Ahmed
Internal Medicine, University of Missouri, Columbia, USA.
Internal Medicine, Howard University Hospital, Washington, D.C., USA.
Cureus. 2020 Dec 19;12(12):e12167. doi: 10.7759/cureus.12167.
Alloimmunization has been reported in patients with sickle cell disease (SCD). Delayed hemolytic transfusion reaction (DHTR) is one of the complications of alloimmunization. DHTR is of particular clinical significance in this patient population as it may pose a diagnostic and management challenge to most healthcare providers. Symptoms of DHTR are often misinterpreted as pain crisis or worsening of baseline anemia. Furthermore, DHTR may take a turn for the worse in patients with SCD, thereby leading to worsening anemia and hyper-hemolytic crisis. In this report, we discuss the case of a 33-year-old African female, with hemoglobin SS (Hb SS) SCD and a history of multiple blood transfusions in her home country of Nigeria, who presented to the emergency department with generalized body pain, which was typical of her prior vaso-occlusive crisis (VOC). The trigger of her crisis was an acute onset of sepsis secondary to associated pyelonephritis. Owing to a worsening of her VOC and a significant drop in her steady-state Hb levels, she required a blood transfusion of one unit of packed red blood cells (PRBC), which was later complicated by a delayed hemolytic reaction and worsening anemia.
镰状细胞病（SCD）患者中已报道有同种免疫现象。迟发性溶血性输血反应（DHTR）是同种免疫的并发症之一。DHTR在该患者群体中具有特殊的临床意义，因为它可能给大多数医疗服务提供者带来诊断和管理方面的挑战。DHTR的症状常被误解为疼痛危象或基线贫血加重。此外，SCD患者的DHTR可能会恶化，进而导致贫血加重和高溶血性危象。在本报告中，我们讨论了一名33岁非洲女性的病例，她患有血红蛋白SS（Hb SS）型SCD，在其祖国尼日利亚有多次输血史，因全身疼痛到急诊科就诊，这是她之前血管闭塞性危象（VOC）的典型症状。此次危象的诱因是继发于相关肾盂肾炎的急性脓毒症发作。由于她的VOC恶化且稳态血红蛋白水平显著下降，她需要输注1单位浓缩红细胞（PRBC），随后出现了迟发性溶血反应和贫血加重。
