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A man with fever and haemoglobinuria after blood transfusion

2018; BMJ; Linguagem: Inglês

10.1136/bmj.k3138

0959-8138

Ammaarah Said, Efthymia Vlachaki, Jibril Abukar, Dimitris A. Tsitsikas,

Erythrocyte Function and Pathophysiology

A 32 year old Afro-Caribbean man with HbSS homozygous sickle disease was admitted with vaso-occlusive crisis affecting his chest wall. Over 24 hours, he developed acute chest syndrome with worsening chest pain, hypoxia, tachypnoea, and new bibasal infiltrates on radiography. He was managed with oxygen, intravenous antibiotics, and automated red cell exchange transfusion. He was transfused with 12 units of red blood cells. The man’s respiratory symptoms improved, but four days after the transfusion he developed intermittent fevers, jaundice, and haemoglobinuria (table 1). View this table: Table 1 Progression of haemoglobin On day 5 he underwent a simple transfusion with a further 2 units of red blood cells, but there was no improvement in his symptoms. His haemodynamic parameters remained stable, however, and there were no new radiological changes. Peripheral blood smears before the exchange transfusion showed sickle cells, polychromatophilic red blood cells, and target cells, which is consistent with sickle cell anaemia (fig 1). Fig 1 Peripheral blood smears were repeated on day 6 after the exchange transfusion and showed spherocytes and erythroblasts (fig 2). Fig 2 ### 1. What is the diagnosis? The progressive drop in haemoglobin to below pre-transfusion levels suggests a diagnosis of hyperhaemolysis—a well recognised but rare transfusion reaction predominantly encountered in patients with homozygous sickle disease. Haemolysis of donor and recipient red blood cells is a key characteristic of the condition; the spherocytes …