Intravascular hemolytic transfusion reaction: Difference between revisions
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*Treat shock with volume and [[vasopressors]] | *Treat shock with volume and [[vasopressors]] | ||
*Treat coagulopathy with [[FFP]] | *Treat coagulopathy with [[FFP]] | ||
*Consider IV methylprednisolone | |||
*Contact ICU | |||
==Disposition== | ==Disposition== |
Revision as of 22:13, 16 April 2024
Background
- Occurs due to ABO incompatibility
- High mortality. 1:30 may die.
Clinical Features
- High grade fever, back/flank pain, headache, hypotension, dyspnea, pulmonary edema, bleeding, renal failure, hematuria
- Sick and shocky
Differential Diagnosis
Transfusion Reaction Types
- Acute
- Delayed
Acute allergic reaction
- Allergic reaction/urticaria
- Anaphylaxis
- Angioedema
- Anxiety attack
- Asthma exacerbation
- Carcinoid syndrome
- Cold urticaria
- Contrast induced allergic reaction
- Scombroid
- Shock
- Transfusion reaction
Evaluation
- Labs consistent with hemolysis
- Send off coombs test/direct antiglobin test
- Coomb's reagent binds RBCs with Ab on them
Management
- Stop transfusion
- Replace all tubing
- Risk of death is proportional to amount of incompatible blood received
- Maintain urine output with IVF (1-2 mL/kg/hr), mannitol, and furosemide as needed
- Treat shock with volume and vasopressors
- Treat coagulopathy with FFP
- Consider IV methylprednisolone
- Contact ICU