hemolytic transfusion reaction
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Classification
- immediate immunologic transfusion reactions
- acute intravascular hemolysis (acute hemolytic transfusion reaction)
- urticarial reactions
- anaphylaxis
- febrile non-hemolytic reactions
- platelet alloantibodies
- transfusion-related acute lung injury
- delayed immunologic transfusion reactions
- delayed immune hemolysis
- graft vs host disease
- transfusion-related immune suppression
- immune-mediated thrombocytopenia (ITP)
Etiology
- acute intravascular hemolysis (acute hemolytic transfusion reaction)
- clinical errors: misidentification of patient or patient's blood specimen accounts for the majority of fatal transfusion reactions
- caused by ABO incompatible plasma or red cells
- involves complement-fixing IgG & IgM antibodies
- delayed immune hemolysis
- sensitization to RBC antigens (not ABO):
- esp. Rh, Kidd, Duffy, MNS antigens
- anamnsetic production of non-complement fixing IgG antibodies
- extravascular removal of antibody-coated RBCs
- sensitization to RBC antigens (not ABO):
Epidemiology
- delayed immunologic transfusion reactions
- delayed immune hemolysis
- incidence: 1 in 5000 (occurs in previously transfused patients or multiparous women)
- delayed immune hemolysis
Pathology
- immediate immunologic transfusion reactions
- delayed immunologic transfusion reactions
- delayed immune hemolysis
- sensitization to RBC antigens (not ABO)
- anamnsetic production of non-complement fixing IgG
- extravascular removal of antibody-coated RBCs
- delayed immune hemolysis
Clinical manifestations
- acute intravascular hemolysis (acute hemolytic transfusion reaction)
- fever
- tachycardia
- hypotension
- dyspnea
- acute renal failure
- pain at infusion site
- chest pain
- flank pain & abdominal pain
- incidence < 1:50,000
- delayed immune hemolysis
- anemia; fever; arthralgia; renal failure (mild)
- delayed hemolytic reaction typically occurs 4-13 days (2-10 days)[4] after transfusion
Laboratory
- immediate immunologic transfusion reactions
- acute intravascular hemolysis (acute hemolytic transfusion reaction)
- urine appearance: red urine
- hemoglobin in urine: hemoglobinuria
- plasma free hemoglobin positive (red plasma, hemoglobinemia)
- direct antiglobulin test (Coomb's test) is positive
- serum bilirubin & DIC panel
- repeat cross match
- acute intravascular hemolysis (acute hemolytic transfusion reaction)
- delayed immunologic transfusion reactions
- delayed immune hemolysis
- complete blood count (CBC): drop in hemoglobin
- serum LDH: increased
- serum bilirubin: hyperbilirubinemia
- positive direct antiglobulin (Coomb's) test
- reticulocyte count: increased
- serum haptoglobin: decreased
- a new alloantibody appears in
- delayed immune hemolysis
Management
- immediate immunologic transfusion reactions
- acute intravascular hemolysis (acute hemolytic transfusion reaction)
- stop transfusion
- clotted & EDTA-treated blood specimens along with patient's blood & tubing should be sent to lab
- send freshly voided urine to lab for free hemoglobin
- intravenous hydration
- support blood pressure
- maintain urine output at 100 mL/hr with IV fluids, diuretics, & mannitol if necessary
- NaHCO3 to alkalinize urine may aid in excretion of hemoglobin
- acute intravascular hemolysis (acute hemolytic transfusion reaction)
- delayed immunologic transfusion reactions
- delayed immune hemolysis
- prevention
- wallet card identifying alloantibodies
- transfusion with compatible blood
- patient education
- prevention
- delayed immune hemolysis
More general terms
More specific terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 615-616
- ↑ The Washington Manual of Medical Therapeutics, 29th edition, Carey, CF et al (eds), Lippincott-Raven, Philadelphia, 1998, pg 272-73
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 790
- ↑ 4.0 4.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2012, 2015, 2018, 2022.
- ↑ Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood. 2009 Apr 9;113(15):3406-17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19188662
- ↑ Panch SR, Montemayor-Garcia C, Klein HG. Hemolytic Transfusion Reactions N Engl J Med 2019; 381:150-162 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31291517 https://www.nejm.org/doi/full/10.1056/NEJMra1802338