Diamond W J, Brown F L, Bitterman P, Klein H G, Davey R J, Winslow R M
Ann Intern Med. 1980 Aug;93(2):231-4. doi: 10.7326/0003-4819-93-2-231.
Eighteen patients with sickle-cell disease underwent partial exchange transfusion. Three developed delayed hemolytic reactions, with selective disappearance of transfused cells. All reactions occurred within 6 days of transfusion, and patients presented with the clinical features of painful crises. The two most severe reactions were associated with antibodies to Jka. These patients developed fever, arthritis, and a clinical course suggesting serum sickness. In both patients, other alloantibodies had previously been seen. A fourth patient developed multiple alloantibodies, accelerated destruction of tranfused cells, but milder illness. Such reactions may be commoner than in appreciated and should be suspected when patients have recurrent or severe sickle crises after transfusion. Blood that is nonimmunogenic in antigen systems frequently associated with delayed hemolytic reactions (Rh, Kell, Duffy, and Kidd) is preferred for sickle-cell patients who lack these antigens, especially if these patients have previously demonstrated capability to form erythrocyte alloantibodies.
18例镰状细胞病患者接受了部分换血治疗。3例发生了迟发性溶血反应，输入的细胞选择性消失。所有反应均发生在输血后6天内，患者表现出疼痛危象的临床特征。最严重的两例反应与抗Jka抗体有关。这些患者出现发热、关节炎，临床病程提示血清病。这两名患者之前均曾出现过其他同种抗体。第四名患者产生了多种同种抗体，输入细胞的破坏加速，但病情较轻。此类反应可能比人们意识到的更为常见，当患者输血后出现复发性或严重镰状危象时应怀疑有此类反应。对于缺乏与迟发性溶血反应相关抗原系统（Rh、Kell、Duffy和Kidd）中抗原的镰状细胞病患者，尤其是那些之前已证明有形成红细胞同种抗体能力的患者，最好输注在这些抗原系统中无免疫原性的血液。
