Milner P F, Squires J E, Larison P J, Charles W T, Krauss J S
South Med J. 1985 Dec;78(12):1462-9. doi: 10.1097/00007611-198512000-00016.
We describe ten patients with sickle cell anemia who became acutely ill within a few days after a blood transfusion. Two patients died. In eight cases the posttransfusion detection of alloantibodies suggested that delayed hemolytic reactions to transfusion were involved in precipitating the acute illness. In some cases the illnesses mimicked vaso-occlusive crises, with bone marrow infarction, while in other cases transient biliary obstruction or transient renal insufficiency was documented. Profound anemia mimicked aplastic crises, but we observed a remarkable capacity of the bone marrow to restore the hemoglobin level without further transfusion. In view of the prevalence of delayed hemolytic transfusion reactions in these patients receiving frequent transfusions and whose red cell antigens differ from those of the white population, we suggest that efforts to more closely match recipient and donor red cell antigens would be clinically, technically, and financially advantageous. Moreover, criteria for transfusion in sickle cell anemia should be strictly scrutinized. Quantitation of transfused hemoglobin A has proved useful in confirming delayed hemolytic reactions in sickle cell disease.
我们描述了10例镰状细胞贫血患者，他们在输血后几天内病情急发。2例患者死亡。在8例病例中，输血后同种抗体检测提示，输血延迟性溶血反应参与了急性疾病的诱发。在某些病例中，疾病表现类似血管阻塞性危象，伴有骨髓梗死，而在其他病例中，记录到短暂性胆管梗阻或短暂性肾功能不全。严重贫血类似再生障碍危象，但我们观察到骨髓在无需进一步输血的情况下恢复血红蛋白水平的显著能力。鉴于这些频繁输血且红细胞抗原与白种人群不同的患者中输血延迟性溶血反应的普遍性，我们建议，在临床上、技术上和经济上，努力使受血者和供血者的红细胞抗原更紧密匹配将具有优势。此外，镰状细胞贫血的输血标准应受到严格审查。已证明，定量输注血红蛋白A有助于确诊镰状细胞病中的输血延迟性溶血反应。
