Transfusion‐induced serum sickness

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2009-02, Vol.49 (2), p.372-345
• Main Authors: Saegeman, Veroniek, Wynendaele, Wim, Kerre, Stefan, Dedeurwaerdere, Franceska, Van den Driessche, Marleen, Moerman, Jan
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Blood. Blood coagulation. Reticuloendothelial system; Creatinine - blood; Humans; Male; Medical sciences; Methylprednisolone - therapeutic use; Middle Aged; Pharmacology. Drug treatments; Serum Sickness - etiology; Serum Sickness - immunology; Transfusion Reaction; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome; Vasculitis, Leukocytoclastic, Cutaneous - complications; Vasculitis, Leukocytoclastic, Cutaneous - etiology; Vasculitis, Leukocytoclastic, Cutaneous - immunology
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2008.01956.x

BACKGROUND: Transfusion‐induced serum sickness reactions are rarely reported in the literature. The Type III hypersensitivity reaction to heterologous proteins involves deposition of complement and immune complexes in small vessel walls resulting in a leukocytoclastic vasculitis. A case of a multiply transfused patient with several episodes of serum sickness reactions is presented. CASE REPORT: A 61‐year‐old man with myelodysplastic syndrome type refractory anemia presented with fever, rash, and polyarthralgia 5 days after transfusion of red blood cells (RBCs). By transfusing plasma‐free “washed” RBCs, similar serum sickness reactions were avoided. RESULTS: Laboratory investigation showed an increase of serum creatinine, hematuria, and proteinuria. Levels of circulating immune complexes immunoglobulin G and immunoglobulin M were increased. Hypocomplementemia could not be demonstrated. Histopathologic examination of the skin showed leukocytoclastic vasculitis, compatible with serum sickness. CONCLUSION: The importance of early recognition of transfusion‐induced serum sickness reactions is emphasized, because this can reduce unnecessary morbidity from this unusual complication of transfusion. To prevent this type of transfusion reaction, patients who experienced serum sickness–like reactions after transfusion should only receive plasma‐free washed RBCs.