Anti-N and anti-Doa immunoglobulin G alloantibody-mediated delayed hemolytic transfusion reaction with hyperhemolysis in sickle cell disease treated with eculizumab and HBOC-201: case report and review of the literature.

BACKGROUND: Delayed hemolytic transfusion reaction (DHTR) with hyperhemolysis is a potentially fatal complication resulting from alloimmunization that can cause severe hemolysis of both transfused and intrinsic red blood cells (RBCs). Patients with sickle cell disease often receive multiple RBC units during their lifetime and thus are likely to develop alloantibodies that increase the risk for DHTR. Treatment to decrease hemolysis includes intravenous immunoglobulin (IVIG), steroids, eculizumab, rituximab, and plasmapheresis in addition to erythropoietin (EPO), intravenous (IV) iron, vitamin B12, and folate to support erythropoiesis. RBC transfusion is preferably avoided in DHTR due to an increased risk of exacerbating the hemolysis. CASE REPORT: We report a rare case of anti-N and anti-Doa immunoglobulin (Ig)G alloantibody-mediated life-threatening DHTR with hyperhemolysis in a patient with hemoglobin SS after RBC transfusion for acute chest syndrome who was successfully treated with eculizumab and HBOC-201 (Hemopure) in addition to steroids, IVIG, EPO, IV iron, and vitamin B12. HBOC-201 (Hemopure) was successfully used as a RBC alternative in this patient. CONCLUSION: Anti-N and anti-Doa IgG alloantibodies can rarely cause severe life-threatening DHTR with hyperhemolysis. HBOC-201 (Hemopure) can be a lifesaving alternative in this scenario. Our report also supports the use of eculizumab in DHTR; however, prospective studies are needed to determine the appropriate dose and sequence of eculizumab administration.

COVID-19 School Closures: Disruptions in School-Based Support Services and Socioemotional Loss Among Middle School Students.

BACKGROUND: In the United States (U.S.), 77% of school district leaders reported that their students had fallen behind in their social-emotional development due to COVID-19 school closures. Although research has measured indicators of social-emotional well-being from the perspective of other informants, little is known about student perceptions of perceived changes in their socioemotional competencies and, to a lesser degree, their nonacademic needs. AIMS: The current study examined middle school students' nonacademic needs, perceptions of socioemotional competencies, and predictors of "socioemotional loss." MATERIALS & METHODS: The authors utilized secondary data from 395 middle school students gathered in August 2020 and November 2020 in one large middle school in the southern region of the U.S. Multivariate and linear regression analyses explored students' nonacademic needs, assessed changes in perceptions of their socioemotional competencies over time, and identified predictors of "socioemotional loss" during the "return to learn" period. RESULTS: Our findings indicated that 3% to 14% of students reported nonacademic needs, with the greatest needs related to food, housing, and healthcare. Further, 48% of students reported perceived losses in their socioemotional competencies, and students formerly receiving school-based support services were those most affected (71% vs. 46%, p = .01). Among the subgroup reporting losses, living in a single-parent household significantly predicted socioemotional loss (ß = -.16, p = .02). DISCUSSION: School-based practitioners, including educators, policymakers, social workers, and mental health providers, can utilize these findings to deliver interventions to students that experienced hardships during the pandemic. CONCLUSION: Responding to these risks will be critical as schools adapt and intervene in response to the COVID-19 pandemic.