Delayed Hemolytic Reactions
TREATMENT: The most important fact to remember when treating a DHTR is that the patient is at risk for the same types of clinical sequelae that are seen in acute hemolytic reactions (such as renal damage, vascular collapse, and DIC).
The fact is that the vast majority of people with delayed HTRs do NOT suffer these potentially disastrous things, but we should be aware of them nonetheless.
In most DHTRs, the patient does not require any treatment whatsoever. As we described in the presentation section, many patients have no clinical problems whatsoever, and if we didn't happen to test the patient and find a new antibody 10 days or so later, no one would have ever known that the patient even had hemolysis. That's OK, by the way, because mild reactions like this don't cause the patient any harm.
The patient who presents with fevers, jaundice, and anemia, on the other hand, may need supportive care, which may include fluids and more close monitoring. Even these patients, though, usually recover just fine without any significant problems. A special issue, though, is dealing with transfusing a patient during this time. Click here for a discussion of transfusion of a patient in the midst of a DHTR.
Finally, there is the patient who presents with serious hemolysis and significant clinical problems as a result of hemolysis. Many of these reactions are due to anamnestic antibodies to the Kidd (Jk) blood group antigens. Kidd antibodies can sometimes fix complement and cause intravascular hemolysis, so these patients must be treated just like patients with an acute intravascular hemolytic transfusion reaction. The foundation of this treatment is vascular support to prevent renal damage and awareness of the possibility of DIC.
Finally, let's discuss the prevention of a DHTR.
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