Which medications have been used off-label in the treatment of delayed hemolytic transfusion reactions (DHTRs)?

Updated: Jan 12, 2021
  • Author: S Gerald Sandler, MD, FCAP, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Randomized controlled studies of delayed hemolytic transfusion reactions have yet to be performed, so no validated treatment approaches or therapy guidelines exist. Off-label treatments described in the literature include the following, used alone or in combination [5, 6] :

  • Intravenous immunoglobulin (IVIg)
  • Recombinant erythropoietin (EPO)
  • Corticosteroids
  • Rituximab – For patients who have developed alloimmunization after DHTR, to prevent further alloimmunization
  • Eculizumab - For some life-threatening episodes

An observational study by Noizat-Pirenne et al demonstrated that pre-transfusion administration of rituximab may have a preventive benefit in SCD patients with a history of severe DHTR. Five of the eight study patients did not develop DHTR, while the remaining three experienced only mild DHTR. No newly formed antibodies were detected in any patient. Because rituximab can have serious adverse effects, these authors suggest that this treatment be considered cautiously, and only when transfusion is absolutely necessary in such patients. [60]

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