Background: Hyperhaemolysis 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 materials: Here, 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.
Results: Following treatment, steady-state haemoglobin was achieved with quiescent haemolysis, and complement inhibition with eculizumab was considered but ultimately not required.
Conclusion: This 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.
Keywords: anti-HI antibody; hyperhaemolysis; transfusion reaction.
© 2023 British Blood Transfusion Society.