Abstract
Background: Hyperhemolysis syndrome (HHS) is a severe delayed hemolytic transfusion reaction seen in sickle cell disease (SCD) patients, characterized by destruction of donor and recipient RBCs. It results in a drop in hemoglobin to below pretransfusion levels and frequently reticulocytopenia.
Case report: We report a case of a man in his thirties with SCD with a recent hospitalization 2 weeks prior for COVID-19. His red cell antibody history included anti-Fy(a) and warm autoantibody. At that time, he was given 2 units of RBC and discharged with a hemoglobin of 10.2 g/dl. He returned to the hospital approximately 1.5 weeks later with hemoglobin 6.0 g/dl and symptoms concerning for acute chest syndrome. Pretransfusion testing now showed 4+ pan-agglutinin in both gel-based and tube-based testing. Alloadsorption identified an anti-N and a strong cold agglutinin. Three least incompatible units were transfused to this patient over several days, with evidence of hemolysis. Further reference lab work revealed anti-Fy a , anti-Fy b , anti-Le a , anti-Le b , and an anti-KN system antibody. The patient’s hemoglobin nadired at 4.4 g/dl. The patient was treated with a single dose of tocilizumab, his hemoglobin stabilized, and he was discharged.
Discussion: We present a case of HHS proximate to recent SARS-CoV-2 infection with multiple allo and autoantibodies identified. Information on the relationship between SARS-CoV-2 infection and HHS is limited; however, it is possible that inflammation related to COVID-19 could predispose to HHS. Tocilizumab is an approved treatment for COVID-19. Additionally, tocilizumab appears to be a promising treatment option for patients with HHS.
Keywords: AIHA/drug-induced IHA; immunohematology (RBC serology, blood groups); transfusion complications-non-infectious.
【저자키워드】 AIHA/drug-induced IHA, immunohematology (RBC serology, blood groups), transfusion complications-non-infectious., 【초록키워드】 COVID-19, Treatment, Inflammation, Hospitalization, Tocilizumab, serology, antibody, SARS-COV-2 infection, hospital, Symptom, Hemolysis, Chest, Patient, hemoglobin, disease, patients, Blood, single dose, Donor, Evidence, autoantibody, Red cell, syndrome, warm, RBCs, lab, Cell, SCD, RBC, approved, characterized, treated, appear, discharged, concerning, returned, incompatible, transfused, treatment for COVID-19, 【제목키워드】 Tocilizumab, SARS-COV-2 infection, Patient, disease, complex, auto, Cell, treated,