Chapter 28 - Acute and Delayed Hemolytic Transfusion Reactions

Abstract

Acute and delayed hemolytic transfusion reactions result from immune-mediated destruction of transfused incompatible packed red blood cells (PRBCs). Acute hemolytic transfusion reactions—although relatively rare—can be devastating. The initial symptoms of fever and chills are seen with both acute and delayed hemolytic as well as in febrile nonhemolytic transfusion reactions, transfusion-related acute lung injury, and transfusion of bacterially contaminated blood. Early evaluation of any suspected reaction is necessary to determine the cause and ensure appropriate management. Delayed hemolytic transfusion reactions are generally less severe and associated primarily with extravascular hemolysis. The volume of incompatible donor red blood cells (RBCs) in circulation in the recipient often determines the severity of the reaction. Other factors such the potency of the anti-A or anti-B in the recipient's plasma also influence the outcome following an incompatible PRBC transfusion. In general, immediate hemolytic transfusion reactions (HTRs) from transfusion of incompatible PRBCs are because of the binding of naturally occurring IgM antibody to donor RBCs. Therapy should focus on management of hypotension or shock, prevention or therapy of disseminated intravascular coagulation, and maintenance of renal perfusion. Infusion of normal saline may be sufficient to manage simple hypotension, but more severe hypotension will require vasopressor therapy. Dopamine, at an infusion rate of 1 gkg of body weight per hour, is the agent of choice because it produces selective vasodilatation to the kidneys. The primary prevention of acute HTRs requires elimination of clerical errors in the process of blood administration Therefore, identifying the specific step in which an error occurred may help prevent future errors and accidents.