A Case of Hyperhemolytic Anemia

Abstract

Delayed hemolytic transfusion reaction (DHTR) is a well-known complication of red blood transfusion. Occasionally, native red cell hemolysis can complicate transfused red cell hemolysis, resulting in a lower post-transfusion hemoglobin. This condition is known as hyperhemolysis syndrome, and is more common after a blood transfusion among patients with sickle cell disease and thalasemia. The occurrence of this syndrome in patients without underlying hemoglobinopathies is rare. A 74-year-old female with a previous history of colonic adenocarcinoma presented to a local hospital with a complaint of diarrhea. She was found to be anemic with hemoglobin of 8.4 g/dL. Her blood was group A, Rh-negative and she received two units of compatible packed red blood cells, after a negative antibody screen was documented. She returned to the hospital 12 days later with complaints of lethargy and fatigue. She was found to be anemic with hemoglobin of 7.8 g/dL. Antibody screening was positive for anti-K antibody. Hemolysis persisted despite receiving K-negative red blood cells, twice during the next 30 days. Both times, her hemoglobin decreased to a level lower than the pre-transfusion value. No other source of bleeding could be identified and a normal hemoglobin electrophoresis was noted. She responded well to 4 weeks of oral prednisone, with no further hemolysis after discontinuation of prednisone therapy. Hyperhemolysis syndrome can occur in patients without hemoglobinopathy, and oral prednisone is an effective treatment. J Hematol. 2016;5(1):38-40 doi: http://dx.doi.org/10.14740/jh266e