Ravulizumab Stabilizes Life-Threating Intravascular Hemolysis Following Delayed Hemolytic Transfusion Reaction due to Alloantibodies Anti-e and Anti-jka: the First Successful Administration

This report describes the first successful use of ravulizumab, a C5 complement inhibitor, to treat life-threatening intravascular hemolysis (IVH) caused by delayed hemolytic transfusion reaction (DHTR) in a 22-year-old woman. The patient developed acute hemolysis and hemodynamic instability after receiving a transfusion for posthemorrhagic anemia following a missed abortion. Seven days later, she presented with symptoms of fatigue, dizziness, and dark urine, with laboratory findings indicating IVH. Investigations revealed anti-e and anti-Jka alloantibodies, suggesting DHTR. Despite conventional treatment, her hemoglobin levels continued to drop, leading to concern for hyperhemolytic syndrome (HHS). After administering ravulizumab, her condition rapidly improved, and she was discharged with stable hemoglobin levels. Follow-up at 8 months showed complete recovery. This case demonstrates the potential of ravulizumab in managing complement-mediated hemolysis in severe transfusion reactions and highlights the need for further research on complement inhibitors in similar conditions.