How do you manage a delayed hemolytic transfusion reaction in a patient with sickle cell disease?

The diagnosis and management of a delayed hemolytic transfusion reaction (DHTR) requires a high index of suspicion. In those patients in whom a DHTR is suspected or confirmed, further RBC transfusion should be withheld unless absolutely necessary, and if then only with the most compatible RBC units. Management involves non-specific measures such as minimizing blood draws as much as possible and if necessary using pediatric tubes. With the belief that there is an immune component to DHTR, I typically use high dose steroids with or without IVIG. It is important to recognize that the use of high dose steroids may be associated with "rebound" pain episodes in SCD. However, it is my opinion that the benefits of steroids outweigh its risks in thi...