Hyperhaemolysis caused by anti‐HI antibodies in a patient with myelodysplastic syndrome following a first ever red cell transfusion

Abstract

AbstractBackgroundHyperhaemolysis is a rare and life‐threatening delayed haemolytic transfusion reaction characterised by complement‐mediated destruction of both host and transfused red cells. It is well recognised as a complication of transfusion in patients with haemoglobinopathies and has occasionally been described in haematological malignancy and anaemia of chronic disease. Anti‐HI antibodies are usually clinically insignificant but have rarely been associated with haemolytic transfusion reactions, including cases of hyperhaemolysis in sickle cell disease.Methods and materialsHere, we describe a novel case of a patient with myelodysplastic syndrome developing hyperhaemolysis as a result of an anti‐HI alloantibody following their first‐ever transfusion. The patient required multiple lines of treatment, including erythropoietin, haematinic supplementation, corticosteroids, intravenous immunoglobulin and rituximab.ResultsFollowing treatment, steady‐state haemoglobin was achieved with quiescent haemolysis, and complement inhibition with eculizumab was considered but ultimately not required.ConclusionThis is the first known report of hyperhaemolysis with an anti‐HI antibody in a non‐haemoglobinopathy patient. The treatment of hyperhaemolysis is evolving, and future commissioning needs to consider the role of complement inhibition in non‐haemoglobinopathy patients.