Hemolytic Transfusion Reactions

Severe reactions usually involve incompatible mismatches in ABO system that are isoagglutinin-mediated

Most cases are due to clerical errors and mislabeled specimens

When hemolysis occurs, it is rapid and intravascular; most reactions occur in surgical patients under anesthesia

Severity depends on RBC dose

Less severe reactions caused by minor antigen systems

Hemolysis is slower and is mediated by IgG antibodies causing extravascular red blood cell destruction; reactions may be delayed for 5–10 days after transfusion

Duffy, Kidd, Kell, and C and E loci of Rh system are antigens most commonly involved

Most transfusion reactions are not hemolytic but related to antigens present on WBCs

Fever, chills, backache, headache

Apprehension, dyspnea, hypotension, vascular collapse

Disseminated intravascular coagulation (DIC)

Acute kidney failure from acute tubular necrosis

Tachycardia, generalized bleeding, and oliguria in patients under general anesthesia

Hemoglobin fails to rise as expected

Acute kidney injury

Acute DIC (low fibrinogen, elevated fibrin degradation products, thrombocytopenia, prolonged prothrombin time)

Hemoglobinemia (plasma pink and hemoglobinuria)

In delayed cases, there is an unexpected drop in hemoglobin and an increase in the total and indirect bilirubins

Offending alloantibody detectable in patient's serum

Stop transfusion immediately

Check identification of recipient and blood

Return transfusion product bag with pilot tube to blood bank with fresh sample of recipient's blood for retyping and repeat of cross-match

Hydrate patient vigorously to prevent acute tubular necrosis. Forced diuresis with mannitol may help prevent or minimize acute kidney injury