Chapter 55 - Acute Hemolytic Transfusion Reactions

Abstract

This chapter focuses on the adverse events termed as acute hemolytic reactions (AHTR) that occur during or following a transfusion. Transfusion of incompatible red blood cells (RBCs) or significant amounts of incompatible plasma, can lead to efficient antibody-antigen binding in the recipient that can activate the complement proteins and lead to intravascular hemolysis. The transfusion of incompatible RBCs is most associated with a mistransfusion event that occur due to incorrectly typed, labeled, crossmatched, issued or transfused to the incorrect patient. AHTR can occur from transfusion of ABO-incompatible blood as well as blood incompatible to other RBC antibodies. The transfusion of significant amounts of incompatible plasma occur less frequently and the passive transfer of donor high-titer anti-A or anti-B in plasma containing products results in hemolysis of the ABO-incompatible recipient's RBCs, which can cause severe morbidity and mortality. Transfusion of incompatible plasma most often occur in the administration of out-of-group platelets, most commonly group O platelets to a group A recipient, which not infrequently result in AHTR.