Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 13-39: Red Blood Cell Transfusions + Key Features Download Section PDF Listen +++ ++ 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 + Clinical Findings Download Section PDF Listen +++ ++ 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 + Diagnosis Download Section PDF Listen +++ ++ 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 + Treatment Download Section PDF Listen +++ ++ 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