Delayed Hemolytic/Serologic Transfusion Reactions (DSHTR): Correlation of Laboratory Findings with the Clinical Manifestations of Hemolysis
Uzuni A, Alhamar M, and Lopez-Plaza I. Delayed Hemolytic/Serologic Transfusion Reactions (DSHTR): Correlation of Laboratory Findings with the Clinical Manifestations of Hemolysis. Vox Sanguinis 2019; 114:226-227.
Background: DSHTR incidence is reported as 1 in 2,500 transfusions, presenting days to months after the transfusion. The published data addressing the correlation between the strength of the antibodies detected after a DSHTR has taken place and the corresponding clinical symptoms as measured by laboratory parameters that assess the presence of hemolysis is limited. Aims: The aim of this study is to evaluate the correlation between the results of the DAT, automated and manual antibody reactivity strength with the corresponding clinical parameters of Hemoglobin, Lactate Dehydrogenase (LDH), Bilirubin, and Haptoglobin. Methods: A DSHTR is defined as discovering a new antibody within 28 days of a transfusion. For all positive antibody screens, a work-up is initiated consisting of identification panels, DATs, antigen typing of the red cells transfused, and eluates at the discretion of the Transfusion Medicine Physician. Additional laboratory testing for hemolysis is requested when indicated. A retrospective review was conducted of patients who were identified as having a DSHTR. Levels of Hemoglobin, LDH, and Bilirubin were recorded within the 28-day period. The clinical parameters were compared against the reaction strength of the antibody reactions. The automated strength was measured by Solid phase. The manual testing consisted of a 15-min incubation using LISS and adding Monospecific IgG. The DAT was performed manually by adding Poly-specific IgG and then testing with Monospecific IgG and C3d. Results: 44 DSHTR cases/54 antibodies present Rh: 17/44 (39%) Non-Rh: 21/44 (47%) Combination: 6/44 (14%)-Rh Group: 6/17 (35%): automated strength of 3+ or 4+ 11/17 (65%): automated strength of 1+ or 2+-Non-Rh Group: 7/21 (33%): automated strength of 3+ or 4+ 14/21 (66%): automated strength of 1+ or 2+-DAT: RH Group: 10/17 (63%): negative result with clinical hemolysis 5/17 (30%): positive result with clinical hemolysis-Non-Rh Group: 13/21 (62%): negative result with clinical hemolysis 5/21 (24%): positive result with clinical hemolysis-Combination Group: 4/7 (57%): negative result with clinical hemolysis evident 3/7 (43%): positive result with clinical hemolysis evident The RH Group and non-Rh group had 11 and 10 cases performed manually, and results were 2+ or weaker further indicating the manual strength did not correlate with the clinical hemolysis. Likewise, in 31/44 (70%) the DAT was negative, and did not show any correlation with clinical hemolysis. However, when LDH and Bilirubin were measured, the two parameters increased as the automated strength of the antibodies increased. Summary/Conclusions: Most of the DSHTR investigation was not associated with overt accelerated red cell destruction. A strong correlation was observed only between the automated immunohematology testing results and other laboratory markers of hemolysis. In our experience, the direct antiglobulin test and manual strength showed no correlation.