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Transfusion Hemolysis

Aka: Transfusion Hemolysis, Immune Transfusion Reaction

See Also
1. Non-Immune Transfusion Reaction
Epidemiology
1. Incidence: Up to 5 per 50,000 transfusions
2. ABO incompatible transfusions are rare (213 events, and 24 deaths between 1996 and 2007)
  1. Vamvakas (2009) Blood 113(15): 3406-17
Types
1. Intravascular Hemolysis
  1. Major incompatibility: ABO
  2. Immediate and massive Hemolysis
2. Extravascular Hemolysis
  1. Minor incompatibility: Rh, xKell, xDuffy, xKid
  2. Delayed RBC destruction in reticuloendothelial
Signs: Intravascular Hemolysis (Major Incompatibility)
1. Rapid and massive Hemolysis to shock state
2. Restlessness or Anxiety
3. Flushing
4. Chest Pain
5. Back pain
6. Tachypnea
7. Tachycardia
8. Nausea
9. Renal Failure
10. Coagulopathy (Disseminated Intravascular Coagulation)
Signs: Extravascular Hemolysis (Minor Incompatibility)
1. Less severe then Intravascular Hemolysis
2. Malaise
3. Fever
4. Shock and Renal Failure are rare
5. Initially red cell survival normal
Labs
1. Document Hemolysis
  1. Plasma Hemoglobin And Hematocrit
  2. Urine Hemoglobin
  3. Haptoglobin
  4. Bilirubin
2. Check Renal Function
  1. Urinalysis
  2. Blood Urea Nitrogen (BUN)
  3. Creatinine
3. Check coagulation status
Management
1. Avoid further transfusions if possible
2. Replace Coagulation Factors as needed
3. Manage shock and Renal Failure

Family Practice Notebook

Patients should address specific medical concerns with their physicians.

Although access to this page is not restricted, the information found here is intended for use by medical providers.

This page was written by Scott Moses, MD, last revised on 12/1/2011 and last published on 5/14/2013.

This is one of 5887 pages in the Family Practice Notebook