Intravascular hemolytic transfusion reaction

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 allergic reaction

Evaluation

  • Labs consistent with hemolysis
  • Send off coombs test/direct antiglobin test
    • Coomb's reagent binds RBCs with Ab on them
Coombs.png

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

Disposition

See Also

External Links

References