Hematology and Oncology Book



Transfusion Hemolysis

Aka: Transfusion Hemolysis, Immune Transfusion Reaction
  1. See Also
    1. Non-Immune Transfusion Reaction
  2. 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]
  3. 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
  4. 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)
  5. 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
  6. 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
      1. Platelet Count
      2. ProTime
      3. Partial Thromboplastin Time (PTT)
  7. Management
    1. Avoid further transfusions if possible
    2. Replace Coagulation Factors as needed
    3. Manage shock and Renal Failure

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