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 administration of ravulizumab, a C5 complement inhibitor, in the treatment of life-threatening intravascular hemolysis (IVH) caused by delayed hemolytic transfusion reaction (DHTR) in a 22-year-old woman. The patient developed acute IVH with severe anemia and hemodynamic instability seven days after receiving a blood transfusion for posthemorrhagic anemia following a missed abortion. Laboratory investigations revealed anti-e and anti-Jka alloantibodies consistent with DHTR. Despite treatment, her hemoglobin level declined further, raising concerns for hyperhemolytic syndrome. After the administration of ravulizumab, her condition improved rapidly, and she was discharged with stable hemoglobin levels. Within three weeks there was full hematologic and biochemical recovery. This case demonstrates the therapeutic potential of ravulizumab in the management of severe complement-mediated hemolysis due to DHTR, and highlights the need for further research on complement inhibitors in similar conditions.