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
  • Intravascular hemolytic tranfusion reaction
  • Febrile nonhemolytic tranfusion reaction
  • Allergic tranfusion reaction
  • Transfusion-associated circulatory overload (TACO)
  • Transfusion-related acute lung injury (TRALI)
  • Transfusion-associated graft-versus-host disease
  • Fluid overload
  • Sepsis
• Delayed
  • Extravascular hemolytic tranfusion reaction
  • Graft-vs-host disease
  • Transfusion infections

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

Disposition

• Admission
  • Most frequently to ICU

See Also

• Transfusion reaction