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Adverse Occurrence type:
DSTR observed in 5/7 patients, 71.4%, DHTR in 2/7, 28.6%
Alerting signals, symptoms, evidence of occurrence:
A retrospective study was conducted of 292 patients at the Mayo Clinic who, between 1980 and 1992, received a clinical diagnosis of DHTR or DSTR concurrently with a serologic diagnosis. Red cell alloantibody specificity, the activity of the patient’s reticuloendothelial system, and concurrent immunosuppression were evaluated as potential predictors of the occurrence of DHTR versus DSTR in different patients. The incidence of DHTR or DSTR was 1 in 1899 allogeneic red cell units transfused, with a DHTR:DSTR ratio of 36:64. Alloantibody specificity was the only variable that affected the occurrence of DHTR versus DSTR at the clinical level, with the anti-Jka and anti-Fya specificities, as well as coexisiting specificities, significantly associated with detectable hemolysis (p<0.05).
Demonstration of imputability or root cause:
Serologic diagnosis was based on techniques conforming to the standards of the American Association of Blood Banks (AABB). DAT was performed on samples obtained before and after transfusion. RBC antibodies were eluted. If a patient had experienced a posttransfusion decrease in the blood hemoglobin level (by at least 1 g/dL from the immediate pretransfusion level), absent obvious, alternative explanation for decrease, a diagnosis of DHTR could be made. If alternative explanations existed, at least one more sign or symptom of hemolysis was required for that diagnosis (see alerting signals).
Suggest new keywords:
DSTR (delayed serologic transfusion reaction)
DHTR (delayed hemolytic transfusion reaction)
Vamvakas, E. C., Pineda, A.A., Reisner, R., Santrach, P.J. and Moore, S.B. (1995). The differentiation of delayed hemolytic and delayed serologic transfusion reactions: incidence and predictors of hemolysis. Transfusion 35(1):26-32.
Per Daniela: adv. occ. taxonomy: Harm to a recipient/Immunological complications/Delayed Serologic Reaction
Expert comments for publication:
A DHTR usually manifests between 24 hours and 28 days after a transfusion and clinical or laboratory features of hemolysis are present. Signs and symptoms are similar to AHTR but are usually less severe. DHTR may sometimes manifests as an inadequate rise of post-transfusion hemoglobin level or unexplained fall in hemoglobin after a transfusion. Blood group serology usually shows abnormal results. There is a DSTR when, after a transfusion, there is demonstration of clinically significant antibodies against red blood cells which were previously absent (as far as is known) and when there are no clinical or laboratory features of hemolysis. This term is synonymous with alloimmunization.