Case 34 – update 4

Our patient with sickle cell anaemia has been investigated for a delayed haemolytic transfusion reaction. However, the reticulocyte count was not elevated and the direct antiglobulin test was not positive as would be expected. Similarly there was no new antibody detected in the patient, despite intensive investigations. The red cell panels post transfusion were similar to those pre transfusion, although we were not able to repeat the cross match.

One possibility is hyperhaemolysis syndrome whereby the patient’s own red cells and the donor red cells are broken down, possibly due to activated macrophages.

Our patient’s haemoglobin drops to 37g/L and she becomes symptomatic.

Questions:

  • What is your next move?

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