Delayed and acute hemolytic transfusion reactions resulting from red cell antibodies and red cell–reactive HLA antibodies

Abstract

Background ： It has been controversial whether HLA antibodies cause

HLA alloimmunization is associated with RBC antibodies in multiply transfused patients with sickle cell disease

“…Awareness of HLA alloimmunization in SCD is important in multiple clinical scenarios and may help to identify individuals who will be at risk for a poor outcome from HCT due to either graft rejection or platelet transfusion refractoriness. Additionally, in rare cases, HLA alloantibodies may play a role in immune-mediated hyperhemolytic transfusion complications [34,44]. If HLA antibodies with high PRA are identified in SCD patients, blood transfusion therapy could potentially be modified by restricting blood donors to a pool of HLA-matched individuals to decrease further HLA alloimmunization in potential transplant patients.…”

“…HLA alloimmunization may also impact RBC transfusion therapy, as it has been associated with decreased RBC survival and hemolysis of allogeneic transfused RBC [32,33]. Although HLA antibodies may be inconsequential in most RBC transfusions, there is evidence that in rare circumstances including transfusion of Bg + RBCs, HLA alloantibodies may be associated with immune-mediated, delayed hyperhemolytic transfusion reactions (DHTR) [32,34,35]. …”

Hyperhemolysis in Patients With Hemoglobinopathies: A Single-Center Experience and Review of the Literature

“…Although usually HLA antibodies do not cause any problems in vivo, there are some reported cases of HTR as a result of HLA antibodies [23,49,50]. Takeuchi et al [51] discuss a patient who developed a DHTR with new alloantibodies after a first transfusion. After a repeat transfusion a few days later, she again dropped her Hb, but in this instance, no alloantibodies were identified.…”

“…Although most HLA antigens that are present on immature red cells disappear as the cells mature, some persist on red cells; these are known as the "Bennett-Goodspeed" Bg antigens and include Bg a (HLA-B7), Bg b (HLA-B17), and Bg c (HLA-A28/A2) [50,51]. In most cases, the antibodies to these antigens are not felt to cause clinically significant problems as far as red cell transfusions are concerned.…”

When a transfusion in an emergency service is not really urgent: hyperhaemolysis syndrome in a child with sickle cell disease

“…This makes advisable to perform a PCR-based DNA typing in these patients; (4) role of human leucocyte antigen (HLA) antibodies: as there is a lack of identifiable post-transfusion RBC alloantibodies to justify the syndrome, something else must activate the complement (HLA, proteins, etc) and produce lysis of red cells. Multireactive HLA antigens have been detected in a case of acute post-transfusion haemolytic reaction 16. Some HLA antigens only present in immature RBC may persist on mature red cells (Bennet-Goodspeed antigens) and have been described as a cause of post-transfusion intravascular haemolysis in rare cases 1…”