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Peer-reviewedCC BYAnnals of hematology

Safety of red blood cell transfusion despite serologic incompatibility in autoimmune hemolytic anemia: A real-world multicenter study.

  • Claudia Cammarata1
  • Simona Raso2
  • Marta Mattana3
  • Riccardo Tomasello2
  • Giulia Maria Camarda2
  • Simona D'Angelo2
  • Elisabetta Scirè4
  • Maria Ilaria Dilena5
  • Roberta Fedele6
  • Sergio Siragusa7
  • Mariasanta Napolitano8,9
9 affiliations
  1. 1PO. "Sant'Elia", Caltanissetta, Italy.
  2. 2Hematology and Rare Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
  3. 3Department of precision medicine in medical, surgical and critical care (Me.Pre.Cc), University of Palermo, Palermo, Italy.
  4. 4UOC Medicina Trasfusionale AOUP Paolo Giaccone, Palermo, Italy.
  5. 5UOS Direzione Medica di Presidio - AOOR Villa Sofia- Cervello, Palermo, Italy.
  6. 6UOC Medicina Trasfusionale e dei Trapianti, AOOR Villa Sofia- Cervello, Palermo, Italy.
  7. 7Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities (PROMISE), ITA University of Palermo, Palermo, Italy.
  8. 8Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities (PROMISE), ITA University of Palermo, Palermo, Italy. [email protected].
  9. 9Hematology and Rare Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy. [email protected].
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Abstract

Red blood cell transfusion in Autoimmune Hemolytic Anemia (AIHA) poses significant clinical challenges due to pan-reactive autoantibodies that interfere with cross-matching, often raising concerns regarding the safety of transfusing serologically "incompatible" blood. This retrospective multicenter study evaluated the frequency, management criteria, and safety profile of red blood cell transfusions in a cohort of adult patients affected by AIHA with a specific focus on transfusion management in the setting of serologic incompatibility. We analyzed 93 adult patients diagnosed with AIHA at two hematology referral centers in Palermo, Italy, between 2020 and 2025. Transfusion support was required in 31.2% (N = 29) of patients. Decisions were mainly guided by a "double trigger" of low hemoglobin (mean 6.3 g/dL) and symptoms of tissue hypoxia, rather than by fixed hemoglobin thresholds. Notably, 61.1% of characterized units were serologically "incompatible" due to autoantibodies. Despite this, the adverse reaction rate was extremely low (1.2% per unit), with no hemolytic reactions recorded. This safety profile was likely supported by concomitant immunosuppressive therapy (89.6% of transfused patients), acting as "biological premedication". Splenomegaly was identified as a marker for higher transfusion dependence (41.2% vs. 29.5%). Transfusion in AIHA is a safe and effective life-saving measure when managed with appropriate immunohematological oversight. Red blood cell transfusion in AIHA appears safe and effective when clinically indicated and managed with appropriate immunohematologic oversight, even in the presence of persistent serologic incompatibility. Transfusion support should not be delayed solely because of crossmatch incompatibility once clinically significant alloantibodies have been reasonably excluded.

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Cite

BibTeXRIS
BibTeX
@article{cammarata2026safety,
  title = {{Safety of red blood cell transfusion despite serologic incompatibility in autoimmune hemolytic anemia: A real-world multicenter study.}},
  author = {Claudia Cammarata and Simona Raso and Marta Mattana and Riccardo Tomasello and Giulia Maria Camarda and Simona D'Angelo and Elisabetta Scirè and Maria Ilaria Dilena and Roberta Fedele and Sergio Siragusa and Mariasanta Napolitano},
  journal = {Annals of hematology},
  year = {2026},
  month = jul,
  doi = {10.1007/s00277-026-07188-6},
  url = {https://europepmc.org/article/MED/42894024},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Safety of red blood cell transfusion despite serologic incompatibility in autoimmune hemolytic anemia: A real-world multicenter study.
AU  - Claudia Cammarata
AU  - Simona Raso
AU  - Marta Mattana
AU  - Riccardo Tomasello
AU  - Giulia Maria Camarda
AU  - Simona D'Angelo
AU  - Elisabetta Scirè
AU  - Maria Ilaria Dilena
AU  - Roberta Fedele
AU  - Sergio Siragusa
AU  - Mariasanta Napolitano
PY  - 2026
DA  - 2026/07/01
JO  - Annals of hematology
DO  - 10.1007/s00277-026-07188-6
UR  - https://europepmc.org/article/MED/42894024
AB  - Red blood cell transfusion in Autoimmune Hemolytic Anemia (AIHA) poses significant clinical challenges due to pan-reactive autoantibodies that interfere with cross-matching, often raising concerns regarding the safety of transfusing serologically "incompatible" blood. This retrospective multicenter study evaluated the frequency, management criteria, and safety profile of red blood cell transfusions in a cohort of adult patients affected by AIHA with a specific focus on transfusion management in the setting of serologic incompatibility. We analyzed 93 adult patients diagnosed with AIHA at two hematology referral centers in Palermo, Italy, between 2020 and 2025. Transfusion support was required in 31.2% (N = 29) of patients. Decisions were mainly guided by a "double trigger" of low hemoglobin (mean 6.3 g/dL) and symptoms of tissue hypoxia, rather than by fixed hemoglobin thresholds. Notably, 61.1% of characterized units were serologically "incompatible" due to autoantibodies. Despite this, the adverse reaction rate was extremely low (1.2% per unit), with no hemolytic reactions recorded. This safety profile was likely supported by concomitant immunosuppressive therapy (89.6% of transfused patients), acting as "biological premedication". Splenomegaly was identified as a marker for higher transfusion dependence (41.2% vs. 29.5%). Transfusion in AIHA is a safe and effective life-saving measure when managed with appropriate immunohematological oversight. Red blood cell transfusion in AIHA appears safe and effective when clinically indicated and managed with appropriate immunohematologic oversight, even in the presence of persistent serologic incompatibility. Transfusion support should not be delayed solely because of crossmatch incompatibility once clinically significant alloantibodies have been reasonably excluded.
SN  - 0939-5555
SN  - 1432-0584
ER  -