The first case of hyperfibrinolysis induced by delayed hemolytic transfusion reaction in a trauma patient

Abstract

PREVIEW

Introduction
Although delayed hemolytic transfusion reaction (DHTR) is a rare transfusion reaction, its occurrence is more frequent in trauma patients¹ and it is the leading cause of transfusion-associated morbidity and mortality². Alloimmunization sensitized by previous transfusions or pregnancy and subsequent immune hemolytic reactions to red blood cells (RBC) induces DHTR.
In terms of a hemolytic reaction, one study reported in vitro results that RBC and platelet lysates could enhance or diminish  fibrinolysis³. Similarly, downstream consequences could clinically affect the hemostatic state of the patient. However, to our knowledge, there has been no clinical documentation reporting downstream changes in global coagulation states after DHTR. Among the testing methods, global coagulation tests such as rotational thromboelastometry (ROTEM, Tem International GmbH, München, Germany) or thrombelastography provide details on hemostatic states⁴. Specifically, in combination with extrinsically activated ROTEM (EXTEM) and a test using aprotinin inhibitor (APTEM) of ROTEM in place of routine coagulation tests, fibrinolysis can be reliably detected5. Here, we report the first case of hyperfibrinolysis detected using ROTEM in a patient with DHTR. This study was conducted in accordance with the Declaration of Helsinki and exempted from review by the ethics committee of Chonnam National University Hospital (CNUH), Gwangju, Korea (CNUH-EXP-2022-399).