Rituxumab to prevent transfusion reactions – pro
Delayed hemolytic transfusion reaction (DHTR), a life-threatening transfusion complication in sickle cell disease (SCD), is characterized by a marked hemoglobin drop with the destruction of both transfused and autologous red blood cells (RBCs) and exacerbation of SCD symptoms. One mechanism of RBCs destruction is auto-antibody production secondary to transfusion. Rituximab specifically targets circulating B cells, and significant literature supports its use to prevent transfusion reactions.
NHS recommends it for this purpose. Its Clinical Commissioning Policy is that rituximab and eculizumab for the prevention and management of delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies [URN 1821] [200602P] Commissioning position Summary Rituximab and eculizumab is recommended to be available as a treatment option through routine commissioning for delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies within the criteria set out in this document.
Noizat-Pirenne F, Bachir D, Chadebech P, Michel M, Plonquet A, Lecron JC, Galactéros F, Bierling P. Rituximab for prevention of delayed hemolytic transfusion reaction in sickle cell disease. Haematologica. 2007 Dec;92(12):e132-5.
Fabian Zanchetta-Balint et al, Rituximab for Preventing Delayed Hemolytic Transfusion Reaction (DHTR) in Sickle CELL Adult Patients: Outcome of Transfusion and SIDE Effects in 58 CASES. Blood Volume 134, Supplement 1, 13 November 2019, Page 3687
Clinical Commissioning Policy; Rituximab and eculizumab for the prevention and management of delayed haemolytic transfusion reactions and hyperhaemolysis in patients with haemoglobinopathies [URN 1821] [200602P]