Immediate Hemolytic Transfusion Reactions

Immediate Hemolytic Transfusion Reactions • Catastrophic and life threatening with mortality 20-60% • Hemolysis of the donor RBC → ARF, DIC, death • Intravascular and extravascular (RES) • Antibodies anti-A,B, Kell, Kidd, Lewis, and anti-Duffy • Ag-Ab complex → activate Hageman factor(XII)→ kinin→ bradykinin → ↑ capillary permeability, also complement → histamine , serotonin • S/S: fever, chills, N&V, diarrhea, rigor, flushing, hypotension, tachy, chest and abdominal pain • Under GA most of S/S are masked only hypotension, tachycardia, ↑ bleeding, Hemoglobinuria • Management: (keep index of suspicion) o Stop Tx, re-check blood, o 3 main objectives:  Maintain BP → volume, inotrops  Preserve renal function→ diuretics, alk the urine (NaHCO3)  Prevent DIC → no specific therapy, maintain BP, prevent stasis

o Blood sample should be collected in EDTA tubes for re-X match, direct coombs test ( for definitive diagnosis) o Pt screen for antibodies o PT, PTT, TT, fibrinogen, D-dimer • Other causes of hemolysis: over heating prior to Tx, and use of hypotonic solution to dilute the blood Delayed Hemolytic Transfusion Reactions • Delayed 1-2 wks after the Tx • Extravascular • Mainly Rh and kidd antibodies • S/S low grade fever, ↑ bili, mild jaundice, and ↓ Hgb • Dx by direct coombs test • Self limiting