Delayed Hemolytic Transfusion Reaction (DHTR), anti-C, anti-S

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Case report
Time to detection: 
10 -11 days
Alerting signals, symptoms, evidence of occurrence: 
Fever, pain in back abdomen and lower extremities. Patient also had new right sided weakness with decreased sensation.
Demonstration of imputability or root cause: 
Remote history of anti-C that was not known to the patient or her family. Positive direct antiglobulin test (DAT) with IgG after second transfusion. Presence of anti-C and anti-S in serum and and anti-C in red cell eluate. Drop in hemogobin with increased LDH. Patient had right sided weakness which resolved within few days. There is no definite evidence that this weakness was due to the transfusion reaction or a coincidence.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Sickle Cell Disease
Delayed hemolytic transfusion reaction
Pain crisis
Cerebrovascular accident
Reference attachment: 
Suggest references: 
Mintz PD, Williams ME. (1986). Cerebrovascular accident during a delayed hemolytic transfusion reaction in a patient with sickle cell anemia. Annals of clinical and laboratory science 16:214-8
Expert comments for publication: 
Incidence of delayed hemolytic transfusion reactions (DHTR) are much higher in patients with sickle cell disease (SCD) compared to random patients who have received transfusions. DHTR may present with a number of distinctive features. In addition to the usual laboratory manifestations of hemolysis, patients may develop symptoms characteristic of a sickle cell pain crisis, and life-threatening anemia may develop as a result of drops in hemoglobin (Hb) and hematocrit (Hct) to levels markedly lower than those before transfusion. These conditions were labeled as sickle cell hemolytic transfusion reactions by Petz et al (Transfusion 1997). Others have also described hyperhemolysis after transfusion therapy, wherein in addition to the allo-red cells, patients own red cells are hemolysed. In this case report also patient presents with pain crisis following first transfusion with demonstration or previously known anti-C and new anti-S. In addition in this case patient had transient right sided weakness.