Rituximab for prevention of delayed hemolytic transfusion reaction in sickle cell disease

• Published in: Haematologica (Roma) Vol. 92; no. 12; pp. e132 - e135
• Main Authors: Noizat-Pirenne, F, Bachir, D, Chadebech, P, Michel, M, Plonquet, A, Lecron, J.-C, Galacteros, F, Bierling, P
• Format: Journal Article
• Language: English
• Published: Italy Ferrata Storti Foundation 01-12-2007
• Subjects: Adult; Anemia, Hemolytic, Autoimmune - blood; Anemia, Hemolytic, Autoimmune - etiology; Anemia, Hemolytic, Autoimmune - immunology; Anemia, Hemolytic, Autoimmune - therapy; Anemia, Sickle Cell - blood; Anemia, Sickle Cell - complications; Anemia, Sickle Cell - immunology; Anemia, Sickle Cell - therapy; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Murine-Derived; Autoantibodies - blood; B-Lymphocytes - immunology; B-Lymphocytes - metabolism; Cell Behavior; Cellular Biology; Erythrocyte Transfusion - adverse effects; Erythrocytes - immunology; Erythrocytes - metabolism; Hemolysis - drug effects; Hemolysis - immunology; Humans; Immunologic Factors; Immunology; Immunotherapy; Life Sciences; Rituximab; Santé publique et épidémiologie; Subcellular Processes
• ISSN: 0390-6078; 1592-8721
• DOI: 10.3324/haematol.12074

1 Etablissement Français du Sang, Ile de France, Hôpital Henri Mondor, Créteil;
2 Centre de Référence des Cytopénies Auto-Immunes, Hôpital Henri Mondor, Créteil;
3 Service des Maladies Génétiques du Globule Rouge, Hôpital Henri Mondor Créteil;
4 Service de Médecine Interne, Hôpital Henri Mondor, Créteil;
5 Laboratoire d’Immunologie, Hôpital Henri Mondor, Créteil;
6 Université de Poitiers, EA 3806, CHU de Poitiers
Correspondence: France Noizat-Pirenne, MD, PhD, Etablissement Français du Sang d’Ile de France, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France. Tel: [phone]; Fax: [phone], E-mail: france.noizat-pirenne{at}efs.sante.fr
Delayed hemolytic transfusion reaction (DHTR), a life-threatening transfusion complication in sickle cell disease (SCD), is characterized by a marked hemoglobin drop with destruction of both transfused and autologous red blood cells (RBCs) and exacerbation of SCD symptoms. One mechanism of RBCs destruction is auto-antibody production secondary to transfusion. As rituximab specifically targets circulating B cells, we thought that it could be beneficial in preventing this immune-mediated transfusion complication. We report the case of a SCD patient who previously experienced DHTR with auto-antibodies and who needed a new transfusion. DHTR recurrence was successfully prevented by rituximab administration prior transfusion, supporting the safe use of rituximab to prevent DHTR in SCD patients as a second line approach when other measures failed.
Key words: Sickle cell disease, rituximab, transfusion, auto-antibodies.