Rarely serum sickness may follow infusion of a blood product. This is the classic Type III hypersensitivity reaction which involves recipient antibody binding to an infused protein.
The onset of a systemic disorders is several days after transfusion of a blood product.
Clinical findings:
(1) fever
(2) skin rash and/or urticaria
(3) polyarthralgia
(4) malaise
(5) myalgia
(6) nausea and vomiting
(7) abdominal pain and/or diarrhea
(8) lymphadenopathy
(9) carditis
(10) renal failure
(11) neuropathy
Laboratory findings:
(1) circulating immune complexes
(2) hypocomplementemia
(3) increased serum creatinine
(4) hematuria and proteinuria
Pathologic findings:
(1) leukocytoclastic vasculitis in a skin biopsy
Future episodes can be avoided by removing the offending protein against which the patient is sensitized. Red blood cell products can be washed to remove any protein. Transfusion of a protein product requires identifying the specific protein and trying to find a product that lacks the protein.
Differential diagnosis:
(1) serum sickness-like reaction to a drug
(2) serum sickness to a protein unrelated to the blood transfusion
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