II. 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 [PubMed]

III. Pathophysiology

  1. IgM or IgG Antibody-mediated Red Blood Cell destruction
  2. Type 2 Hypersensitivity Reaction
  3. Human error in type and cross match process is the most common cause of reaction

IV. Types

  1. Intravascular Hemolytic Transfusion Reaction (Intravascular HTR)
    1. Major incompatibility: ABO
    2. Immediate and massive Hemolysis (acute, within 24 hours of transfusion)
    3. Group A Blood (AA or AO) patients have A-Antigens and Anti-B Antibody that reacts to Group B Blood Antigens
    4. Group B Blood (BB or BO) patients have B-Antigens and Anti-A Antibody that reacts to Group A Blood Antigens
    5. Group O Blood patients have no Antigens, but Anti-A and B Antibody that reacts to Group A and B Blood Antigens
    6. Group AB Blood patients have A and B Antigens, but no Antibody to react to major Antigens
      1. Group AB Blood is considered universal blood recipients (will not react to A, B or O Blood)
      2. Group O Blood is considered universal blood donor (can be given to A, B or O Blood Types without reaction)
  2. Extravascular Hemolysis (Extravascular HTR)
    1. Minor incompatibility: Rh, xKell, xDuffy, xKid
    2. Delayed RBC destruction in reticuloendothelial system (>24 hours after transfusion)

V. Signs: Intravascular Hemolysis (Major Incompatibility)

VI. 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

VII. Differential Diagnosis

  1. See Transfusion Reaction
  2. Non-Immune Hemolysis due to problem with storage or administration
    1. Results in Hemolysis due to physical factors (osmotic, heat, mechanical factors)

IX. Management

  1. Avoid further transfusions if possible
  2. Replace Coagulation Factors as needed
  3. Supportive care
  4. Manage shock and Renal Failure

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Ontology: Hemolytic Transfusion Reaction (C0221123)

Concepts Pathologic Function (T046)
MSH D065227
ICD10 T80.919
SnomedCT 39778006
English Haemolytic transf reaction, Hemolytic transf reaction, hemolytic transfusion reaction (diagnosis), hemolytic transfusion reaction, haemolytic transfusion reaction, transfusion hemolysis, hemolytic reactions transfusion, Hemolytic transfusion reaction NOS, Reactions, Hemolytic Transfusion, Transfusion Reaction, Hemolytic, Hemolytic Transfusion Reactions, Reaction, Hemolytic Transfusion, Hemolytic Transfusion Reaction, Transfusion Reactions, Hemolytic, Haemolytic transfusion reaction, Hemolytic transfusion reaction, Hemolytic transfusion reaction (disorder), Hemolytic transfusion reaction, NOS, Haemolytic transfusion reaction, NOS
Dutch hemolytische reactie op transfusie
French Réaction hémolytique à la transfusion
German haemolytische Transfusionsreaktion
Italian Reazione emolitica trasfusionale
Portuguese Reacção hemolítica à transfusão
Japanese ヨウケツセイユケツハンノウ, 溶血性輸血反応
Czech Hemolytická reakce na transfúzi
Hungarian Haemolyticus transzfúziós reakció
Spanish Reacción hemolítica post-transfusional, reacción hemolítica a una transfusión (trastorno), reacción hemolítica a una transfusión de sangre, reacción hemolítica a una transfusión