{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T07:00:45Z","timestamp":1790319645509,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with sickle cell disease (SCD) are highly predisposed to alloimmunization and severe hemolytic reactions. Hyperhemolysis, a transfusion reaction that causes destruction of transfused and autologous red cells, may occur without new red cell antibody production or with antibodies not considered clinically significant in SCD. Avoidance of transfusions is the key preventative strategy; however, transfusions are unavoidable for SCD patients undergoing hematopoietic stem cell transplant [HSCT]). This case outlines our approach for safe transfusions in an SCD patient undergoing HSCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>\n                      A 15\u2010year\u2010old alloimmunized SCD patient experienced hyperhemolysis after red cell exchange, requiring immune suppressive therapy and a delay in planned HSCT. To ensure safe red blood cell (RBC) transfusions in the peri\u2010transplant period, the patient's humoral immune response was suppressed via Rituximab before pre\u2010transplant red cell exchange. Additionally, the patient and sibling donor had\n                      <jats:italic>RHD<\/jats:italic>\n                      haplotype mismatch with recipient anti\u2010D, which could predispose to delayed red cell engraftment and prolonged posttransplant transfusion requirements. Hence, we used a plasma cell\u2010depleting agent (Daratumumab) pre\u2010transplant. Early and close collaboration with the transfusion laboratory, national immunohematology reference laboratory, and the rare blood program facilitated the timely availability of compatible units via extensive serologic testing, use of monocyte monolayer assay, and donor RBC genotyping. The patient underwent pre\u2010transplant red cell exchange with no hemolytic reactions and had minimal post\u2010transplant transfusion requirements.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Safe transfusions in SCD patients with hyperhemolysis undergoing HSCT require timely collaboration between laboratory and clinical services, careful selection of matched RBC units for transfusion,\u00a0extensive serologic testing, and suppression of humoral immune response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.70358","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:33:38Z","timestamp":1790318018000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Approach to red cell transfusions and stem cell transplant in an alloimmunized sickle cell patient with hyperhemolysis history"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1794-9672","authenticated-orcid":false,"given":"Sarah","family":"Tehseen","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology Oncology University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9227-9712","authenticated-orcid":false,"given":"Georgina","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology Oncology University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6838-2576","authenticated-orcid":false,"given":"Akash","family":"Gupta","sequence":"additional","affiliation":[{"name":"Medical Affairs Division  Ottawa Canada"},{"name":"Canadian Blood Services  Ottawa Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology Oncology University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"e_1_2_8_2_1","article-title":"Alemtuzumab\/low dose TBI conditioning facilitates stable long\u2010term donor hematopoietic cell engraftment from sibling donors in children with sickle cell disease","volume":"130","author":"Guilcher GM","year":"2017","journal-title":"Blood"},{"issue":"3","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.bbmt.2015.08.036","article-title":"Nonmyeloablative stem cell transplantation with alemtuzumab\/low\u2010dose irradiation to cure and improve the quality of life of adults with sickle cell 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