Disseminated Intravascular Coagulation (DIC) Following Acute Hemolytic Transfusion Reaction (AHTR) in a Pregnant Woman in Rural Tanzania: A Case Report
Abdu Hussein Mogella
*
Department of Clinical Medicine, Tanzanian Training Center for International Health, Ifakara, Morogoro, Tanzania, Department of Internal Medicine, Faculty of Medicine, St. Francis University College of Health and Allied Sciences, Ifakara, Morogoro, Tanzania and Division of Haematology and Blood Transfusion, Department of Internal Medicine, St Francis Referral Hospital, Ifakara, Morogoro, Tanzania.
Omary Shaban Kilume
Department of Clinical Medicine, Tanzanian Training Center for International Health, Ifakara, Morogoro, Tanzania and Department of Obstetrics and Gynecology, St. Francis Referral Hospital, Ifakara, Morogoro, Tanzania and Department of Obstetrics and Gynecology, Faculty of Medicine, St. Francis University College of Health and Allied Sciences, Ifakara, Morogoro, Tanzania.
Witness Lubomba
Department of Internal Medicine, Faculty of Medicine, St. Francis University College of Health and Allied Sciences, Ifakara, Morogoro, Tanzania and Division of Haematology and Blood Transfusion, Department of Internal Medicine, St Francis Referral Hospital, Ifakara, Morogoro, Tanzania.
Gabriel Yessaya Nalaila
Department of Obstetrics and Gynecology, St. Francis Referral Hospital, Ifakara, Morogoro, Tanzania.
Martin Rohacek
High Dependency Unit, St Francis Regional Referral Hospital, Ifakara, Morogoro, Tanzania.
Zenais Augustino Mselle
High Dependency Unit, St Francis Regional Referral Hospital, Ifakara, Morogoro, Tanzania.
Theresia Karuhanga
Department of Surgery, Faculty of Medicine, St. Francis University College of Health and Allied Sciences, Ifakara, Morogoro, Tanzania.
Issa Shabani Nyangala
Department of Obstetrics and Gynecology, St. Francis Referral Hospital, Ifakara, Morogoro, Tanzania.
Elias Kweyamba
Department of Clinical Medicine, Tanzanian Training Center for International Health, Ifakara, Morogoro, Tanzania, Department of Obstetrics and Gynecology, St. Francis Referral Hospital, Ifakara, Morogoro, Tanzania and Department of Obstetrics and Gynecology, Faculty of Medicine, St. Francis University College of Health and Allied Sciences, Ifakara, Morogoro, Tanzania.
Emmanuel Chogo
Lugala District Hospital, Malinyi District, Morogoro, Tanzania.
*Author to whom correspondence should be addressed.
Abstract
Background: Acute Hemolytic Transfusion Reaction (AHTR) is a severe transfusion-related complication that may precipitate secondary DIC. This risk is higher in pregnant women, where physiological hypercoagulability can mask early signs.
Case Presentation: We report a 23-year-old gravida 2 para 1 at 36+4 weeks of gestation. She developed DIC secondary to AHTR after transfusion of a suspected incompatible blood component. Within 30 minutes post-transfusion, she developed respiratory distress and fetal compromise. This necessitated an emergency cesarean section. Postoperatively, she had persistent bleeding, severe anemia, and acute kidney injury. Despite supportive therapy including intravenous fluids, antifibrinolytics, antibiotics, and limited blood transfusions, her condition worsened. She developed multi-organ failure and died on day six of admission.
Conclusion: Management of this case was hindered by a lack of confirmatory immunohematology testing. Limited availability of blood components and restricted access to intensive care unit (ICU) services also contributed. Strengthening early recognition of transfusion reactions, enforcing transfusion safety protocols, fostering multidisciplinary collaboration, and improving access to diagnostics and critical care resources are essential.
Keywords: Disseminated intravascular coagulation, acute hemolytic transfusion reaction, transfusion incompatibility, blood components, intravascular hemolysis