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Hemolytic Transfusion Reaction After Preoperative Prophylactic Blood Transfusion for Sickle Cell Disease in Pregnancy

Proudfit, Christine L. MD1; Atta, Emad MD2; Doyle, Nora M. MD, MPH2

doi: 10.1097/01.AOG.0000258784.61584.f5
Case Reports
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BACKGROUND: Preoperative transfusions are frequently given to prevent morbidity in nonpregnant patients with sickle cell disease. We describe a case of a life-threatening delayed hemolytic transfusion reaction with hyperhemolysis syndrome in pregnancy.

CASE: A multigravida with sickle cell disease underwent prophylactic blood transfusion before repeat cesarean delivery. Her immediate postpartum course was uneventful, but on postoperative day number 6 she presented in grave condition with what was thought initially to be an infection versus crisis. Delayed hemolytic transfusion reaction with hyperhemolysis was ultimately diagnosed.

CONCLUSION: In the gravida with sickle cell disease and known multiple red cell antibodies, blood transfusion may incur a higher risk for delayed transfusion reaction, hyperhemolysis syndrome, and possible death. Blood transfusion should be used cautiously in these patients.

A life-threatening delayed hemolytic transfusion reaction with hyperhemolysis syndrome occurring after a precesarean prophylactic blood transfusion for sickle cell disease in pregnancy is described.

From the 1Department of Gynecology and Obstetrics, and 2Division of Maternal Fetal Medicine, Emory University School of Medicine, Atlanta, Georgia.

Corresponding author: Nora M. Doyle, MD, MPH, MS, 69 Jesse Hill Drive NE, Atlanta, GA 30303; e-mail: ndoyle@emory.edu.

Financial Disclosure The authors have no potential conflicts of interest to disclose.

© 2007 The American College of Obstetricians and Gynecologists