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Hemolytic Transfusion Reaction

Hemolysis Transfusion

The hemolytic transfusion reaction is a potentially severe adverse reaction to blood transfusion that may be divided into acute episodes, occurring during the first 24 hours after blood administration and delayed ones, that are often less serious. AB0 incompatibilities cause severe distress, whereas non-AB0 incompatibility leads to milder discomfort. Symptoms occasionally resolve by themselves, but advanced cases require immediate treatment.


Presentation

Any individual that has a history of blood transfusion or pregnancy is a potential candidate for a hemolytic transfusion reaction after blood administration. Initial signs may be nonspecific. An acute episode presents with pulmonary findings such as wheezing tachypnea or dyspnea, cardiovascular abnormalities like tachycardia and hypotension, renal anomalies like anuria or a change of urine color to reddish due to hemoglobinuria and systemic symptoms, such as high fever, chills, headaches, flushing or paleness, loss of consciousness and anxiety [1] [2] [3]. The involvement of digestive system may cause jaundice, nausea, and vomiting. The patient may complain of a chest, back or abdominal pain. If disseminated intravascular coagulation sets in, a bleeding tendency is described later during the course of the disease.

A delayed hemolytic transfusion reaction is often less severe, consisting only of anemia signs and fever, the latter present one week after the incompatible blood transfusion. In other cases, the disease has no specific symptoms and is incidentally discovered during laboratory investigations [4]. Severe complaints usually arise after hemolyzed blood administration.

The magnitude of the hemolytic reaction depends on the volume of incompatible blood that was administered. Even 1 ml of blood can cause a reaction, but complaints usually appear after 5 to 20 ml are administered. If the clinical status declines, the physician should investigate the presence of acute renal failure, disseminated intravascular coagulation, and shock.

Fever
  • The triad of fever, anemia, and a history of recent blood transfusion is the hallmark of this diagnosis.[ncbi.nlm.nih.gov]
  • Patients may experience hemolytic transfusion reactions that are delayed by from a few days to two weeks and manifest as acute hemolysis (hemoglobinuria, jaundice, and pallor), symptoms suggesting severe vaso-occlusive crisis (pain, fever, and acute chest[ncbi.nlm.nih.gov]
  • Six days after the last unit, he had a hemolytic transfusion reaction manifested by high fever, marked fall in hematocrit, hemoglobinemia, hemoglobinuria, severe bilirubinemia and oliguria.[ncbi.nlm.nih.gov]
  • Abstract Delayed hemolytic transfusion reactions (DHTRs) usually occur between 3 and 14 days posttransfusion as a result of a secondary immune response, with a drop in Hb level, fever, jaundice, or hemoglobinuria.[ncbi.nlm.nih.gov]
  • Each presented with fever and hemoglobinuria. All but 1 patient experienced pain initially ascribed to vaso-occlusive crisis. The DAT was positive in only 2 of the 9 episodes.[ncbi.nlm.nih.gov]
Chills
  • Shortly after receiving intravenous iron-dextran, the patient was transfused with two units of crossmatch compatible packed red blood cells and subsequently experienced severe racking chills associated with mild elevation of temperature.[ncbi.nlm.nih.gov]
  • CASE REPORT: A 47-year-old diabetic man with drug-induced pancytopenia suddenly manifested severe shaking chills, flank pain, and back pain during a red cell transfusion.[ncbi.nlm.nih.gov]
  • After the transfusion of 100 mL, the patient had an HTR with chills, fever, and tachycardia and laboratory findings of hemoglobinemia, hemoglobinuria, and negative DATs.[ncbi.nlm.nih.gov]
  • During the transfusion she developed chills, nausea, hypertension, and red-brown urine. The posttransfusion sample plasma was grossly hemolyzed with a strongly positive direct antiglobulin test (DAT) by gel.[ncbi.nlm.nih.gov]
  • Common signs of AHTR are: fever, chills/rigors, facial flushing, chest pain, abdominal pain, back/flank pain,nausea/vomiting,diarrhea, hypotension, pallor, jaundice, oligoanuria, diffuse bleeding, dark urine.[notifylibrary.org]
Rigor
  • Common signs of AHTR are: fever, chills/rigors, facial flushing, chest pain, abdominal pain, back/flank pain,nausea/vomiting,diarrhea, hypotension, pallor, jaundice, oligoanuria, diffuse bleeding, dark urine.[notifylibrary.org]
  • Hemolysis occurs during or within 24 hours of cessation of transfusion and causes new onset of any of the following signs or symptoms: Back or flank pain Chills and/or rigors Disseminated intravascular coagulation (DIC) Epistaxis Fever Hematuria Hypotension[clinlabnavigator.com]
  • In case of non-antibody mediated AHR This does not require rigorous management.[en.wikipedia.org]
  • […] do not quickly resolve, consider the possibility of a haemolytic or bacterial reaction resume transfusion with a different blood unit recurrent FNHTRs patients can be pre-medicated with oral paracetamol (or a non-steroidal anti-inflammatory drug if rigors[gpnotebook.co.uk]
  • […] product bag sent for culture if contamination is suspected or if any of the following clinical indicators are present:  shock  hypertensive (systolic rises 30mm Hg)  hypotensive (systolic falls 30mm Hg)  fever (2ºC or 3.5ºF rise in temperature)  rigors[slideshare.net]
Infusion Site Pain
  • Acute hemolytic transfusion reactions (AHTRs)  Symptoms:  Fever and chills: Most common presenting symptom ( 80%)  Back or infusion site pain  Hypotension/shock  Hemoglobinuria (may be first indication of hemolysis in anesthetized patients)  DIC[slideshare.net]
Fatigue
  • Abstract A 5-year-old male with sickle cell disease presented with pain, dark urine, and fatigue 10 days after a red blood cell (RBC) transfusion. Laboratory evaluation demonstrated severe anemia, blood type O , and anti-D in the serum.[ncbi.nlm.nih.gov]
Nausea
  • During the transfusion she developed chills, nausea, hypertension, and red-brown urine. The posttransfusion sample plasma was grossly hemolyzed with a strongly positive direct antiglobulin test (DAT) by gel.[ncbi.nlm.nih.gov]
  • On Day 6 she started to feel week, tired, with nausea and mild jaundice. Her Hb and Ht had dropped to 99 g/L and 0.33 L/L respectively, with tendency of dropping further (Day 7: Hb 83 g/L, Ht 0.26 L/L).[ncbi.nlm.nih.gov]
  • Common signs of AHTR are: fever, chills/rigors, facial flushing, chest pain, abdominal pain, back/flank pain,nausea/vomiting,diarrhea, hypotension, pallor, jaundice, oligoanuria, diffuse bleeding, dark urine.[notifylibrary.org]
  • The involvement of digestive system may cause jaundice, nausea, and vomiting. The patient may complain of a chest, back or abdominal pain.[symptoma.com]
  • […] blood transfused ( Blood 2009;113:3406 ) Causes 10 – 30 deaths in US each year Clinical manifestations Fever ( important ): early sign of AHTR – need to monitor vital signs frequently during the initial minutes of transfusion Anxiety, sense of doom Nausea[pathologyoutlines.com]
Vomiting
  • Common signs of AHTR are: fever, chills/rigors, facial flushing, chest pain, abdominal pain, back/flank pain,nausea/vomiting,diarrhea, hypotension, pallor, jaundice, oligoanuria, diffuse bleeding, dark urine.[notifylibrary.org]
  • The involvement of digestive system may cause jaundice, nausea, and vomiting. The patient may complain of a chest, back or abdominal pain.[symptoma.com]
  • […] transfused ( Blood 2009;113:3406 ) Causes 10 – 30 deaths in US each year Clinical manifestations Fever ( important ): early sign of AHTR – need to monitor vital signs frequently during the initial minutes of transfusion Anxiety, sense of doom Nausea, vomiting[pathologyoutlines.com]
  • […] transfused major morbidity (requiring intensive care or renal dialysis) occurs in up to 30% of cases while 5–10% of episodes contribute to the death of the patient. symptoms of acute hemolytic transfusion reactions include - fever, chills, rigors, nausea, vomiting[gpnotebook.co.uk]
  • Shock may develop, causing a rapid, feeble pulse; cold, clammy skin; low blood pressure; and nausea and vomiting. Jaundice may follow acute hemolysis.[merckmanuals.com]
Rectal Bleeding
  • She had a history of an ulcerative colitis, blood transfusion because of rectal bleeding, and surgical removal of descendent and sigmoid colon.[ncbi.nlm.nih.gov]
Hypotension
  • Abstract A case of hemolytic transfusion reaction, accompanied by hypotension and followed by transient renal failure, occurred after the transfusion of 1 unit of previously frozen autologous red cells.[ncbi.nlm.nih.gov]
  • Acute hemolytic transfusion reactions (AHTRs)  Symptoms:  Fever and chills: Most common presenting symptom ( 80%)  Back or infusion site pain  Hypotension/shock  Hemoglobinuria (may be first indication of hemolysis in anesthetized patients)  DIC[slideshare.net]
  • Clinical signs include tachycardia, fever and hypotension. Anesthesized patients may exhibit only hemoglobinuria, hemoglobinemia or oozing of blood from cut surfaces. Renal failure and DIC may subsequently occur.[clinlabnavigator.com]
  • Common signs of AHTR are: fever, chills/rigors, facial flushing, chest pain, abdominal pain, back/flank pain,nausea/vomiting,diarrhea, hypotension, pallor, jaundice, oligoanuria, diffuse bleeding, dark urine.[notifylibrary.org]
  • An acute episode presents with pulmonary findings such as wheezing tachypnea or dyspnea, cardiovascular abnormalities like tachycardia and hypotension, renal anomalies like anuria or a change of urine color to reddish due to hemoglobinuria and systemic[symptoma.com]
Tachycardia
  • After the transfusion of 100 mL, the patient had an HTR with chills, fever, and tachycardia and laboratory findings of hemoglobinemia, hemoglobinuria, and negative DATs.[ncbi.nlm.nih.gov]
  • An acute episode presents with pulmonary findings such as wheezing tachypnea or dyspnea, cardiovascular abnormalities like tachycardia and hypotension, renal anomalies like anuria or a change of urine color to reddish due to hemoglobinuria and systemic[symptoma.com]
  • Clinical signs include tachycardia, fever and hypotension. Anesthesized patients may exhibit only hemoglobinuria, hemoglobinemia or oozing of blood from cut surfaces. Renal failure and DIC may subsequently occur.[clinlabnavigator.com]
  • […] culture if contamination is suspected or if any of the following clinical indicators are present:  shock  hypertensive (systolic rises 30mm Hg)  hypotensive (systolic falls 30mm Hg)  fever (2ºC or 3.5ºF rise in temperature)  rigors (shaking chills)  tachycardia[slideshare.net]
  • Signs include fever, tachycardia, hypotension, pain, or shortness of breath [3]. In AHTRs, there may be renal damage due to vasoconstriction.[path.upmc.edu]
Chest Pain
  • When the patient started receiving the implicated unit, she reported back pain, chest pain, and a feeling of anxiety, suggestive of an acute transfusion reaction. The transfusion was ceased and an investigation of an adverse event was commenced.[ncbi.nlm.nih.gov]
  • Common signs of AHTR are: fever, chills/rigors, facial flushing, chest pain, abdominal pain, back/flank pain,nausea/vomiting,diarrhea, hypotension, pallor, jaundice, oligoanuria, diffuse bleeding, dark urine.[notifylibrary.org]
  • Specialty Compatibility Testing Indications If a patient experiences unexplained fever or change in vital signs or symptoms such as chest pain, shortness of breath, back pain, diaphoresis, red urine, or unexplained bleeding, the transfusion should be[bloodworksnw.org]
  • Symptoms include fever, chills, chest pain, back pain, hemorrhage, increased heart rate, shortness of breath, and rapid drop in blood pressure.[projects.juliantrubin.com]
  • In 5 patients (patients 3, 4, 5, 6 and 7), the combination of a fever, chest pain, hypoxemia, and a new pulmonary infiltrate led to a diagnosis of acute chest syndrome.[haematologica.org]
Back Pain
  • When the patient started receiving the implicated unit, she reported back pain, chest pain, and a feeling of anxiety, suggestive of an acute transfusion reaction. The transfusion was ceased and an investigation of an adverse event was commenced.[ncbi.nlm.nih.gov]
  • CASE REPORT: A 47-year-old diabetic man with drug-induced pancytopenia suddenly manifested severe shaking chills, flank pain, and back pain during a red cell transfusion.[ncbi.nlm.nih.gov]
  • While administering the second unit, the patient complained of fever and low back pain, and hemoglobinemia was detected. Anti-Dob was identified in the post-reaction samples by absorption-elution tests, and the patient was confirmed to be Do(a b-).[ncbi.nlm.nih.gov]
  • However, if you develop any complaints, such as a fever, dizziness, shortness of breath, or mild back pain, notify health staff immediately, as this could indicate a transfusion reaction.[healthline.com]
  • Specialty Compatibility Testing Indications If a patient experiences unexplained fever or change in vital signs or symptoms such as chest pain, shortness of breath, back pain, diaphoresis, red urine, or unexplained bleeding, the transfusion should be[bloodworksnw.org]
Low Back Pain
  • While administering the second unit, the patient complained of fever and low back pain, and hemoglobinemia was detected. Anti-Dob was identified in the post-reaction samples by absorption-elution tests, and the patient was confirmed to be Do(a b-).[ncbi.nlm.nih.gov]
Flushing
  • Common signs of AHTR are: fever, chills/rigors, facial flushing, chest pain, abdominal pain, back/flank pain,nausea/vomiting,diarrhea, hypotension, pallor, jaundice, oligoanuria, diffuse bleeding, dark urine.[notifylibrary.org]
  • […] such as wheezing tachypnea or dyspnea, cardiovascular abnormalities like tachycardia and hypotension, renal anomalies like anuria or a change of urine color to reddish due to hemoglobinuria and systemic symptoms, such as high fever, chills, headaches, flushing[symptoma.com]
  • Symptoms may include any of the following: Back pain Bloody urine Chills Fainting or dizziness Fever Flank pain Flushing of the skin Symptoms of a hemolytic transfusion reaction most often appear during or right after the transfusion.[medlineplus.gov]
  • Transfusion reaction symptoms include: back pain dark urine chills fainting or dizziness fever flank pain skin flushing shortness of breath itching In some instances, however, transfusion reactions take place days after the transfusion.[healthline.com]
  • SIGNS AND SYMPTOMS of Hemolytic transfusion reactions: Immediate (intravascular) hemolytic transfusion reaction: Anxiety, Flushing, Tachycardia, Hypotension, Chest or back pain, Dyspnea, Fever, Chills Note: symptoms are masked in anesthetized patient[enotes.tripod.com]
Urticaria
  • Urticaria with No Other Signs or Symptoms. The appearance of an itchy rash during component transfusion, frequently seen with transfusion of platelets or plasma, is a common occurrence.[enotes.tripod.com]
  • After stopping the transfusion, if the urticaria resolves without signs of anaphylaxis, the transfusion can resume. Rarely is urticaria the first sign of a more serious reaction.[ime.acponline.org]
  • The most common symptoms are chills, rigor, fever, dyspnea, light-headedness, urticaria, itching, and flank pain.[merckmanuals.com]
  • Patients typically develop symptoms within minutes and present with common signs of an allergic response: rash, urticaria, and itching .[emdocs.net]
Cold, Clammy Skin
  • Shock may develop, causing a rapid, feeble pulse; cold, clammy skin; low blood pressure; and nausea and vomiting. Jaundice may follow acute hemolysis.[merckmanuals.com]
Flank Pain
  • CASE REPORT: A 47-year-old diabetic man with drug-induced pancytopenia suddenly manifested severe shaking chills, flank pain, and back pain during a red cell transfusion.[ncbi.nlm.nih.gov]
  • Common signs of AHTR are: fever, chills/rigors, facial flushing, chest pain, abdominal pain, back/flank pain,nausea/vomiting,diarrhea, hypotension, pallor, jaundice, oligoanuria, diffuse bleeding, dark urine.[notifylibrary.org]
  • Initial symptoms of hemolysis may include fever, chills, a burning sensation at the IV site, flank pain, anxiety, and tightness in the chest. Clinical signs include tachycardia, fever and hypotension.[clinlabnavigator.com]
  • Symptoms may include any of the following: Back pain Bloody urine Chills Fainting or dizziness Fever Flank pain Flushing of the skin Symptoms of a hemolytic transfusion reaction most often appear during or right after the transfusion.[medlineplus.gov]
  • Transfusion reaction symptoms include: back pain dark urine chills fainting or dizziness fever flank pain skin flushing shortness of breath itching In some instances, however, transfusion reactions take place days after the transfusion.[healthline.com]
Dark Urine
  • Abstract A 5-year-old male with sickle cell disease presented with pain, dark urine, and fatigue 10 days after a red blood cell (RBC) transfusion. Laboratory evaluation demonstrated severe anemia, blood type O , and anti-D in the serum.[ncbi.nlm.nih.gov]
  • Common signs of AHTR are: fever, chills/rigors, facial flushing, chest pain, abdominal pain, back/flank pain,nausea/vomiting,diarrhea, hypotension, pallor, jaundice, oligoanuria, diffuse bleeding, dark urine.[notifylibrary.org]
  • Transfusion reaction symptoms include: back pain dark urine chills fainting or dizziness fever flank pain skin flushing shortness of breath itching In some instances, however, transfusion reactions take place days after the transfusion.[healthline.com]
  • If AHTR occurs while the patient is under general anesthesia, the only symptom may be hypotension, uncontrollable bleeding from incision sites and mucous membranes caused by an associated DIC, or dark urine that reflects hemoglobinuria.[merckmanuals.com]
Confusion
  • I have one more question: in a chronic transplant rejection the MOA in FA is a little confusing. So the grafted CD8 cells are recognized as self by recipient's CD8 cells. so no problem there.[forums.studentdoctor.net]
Agitation
  • The patient will present with chills, agitation, fever, tachycardia, hypotension, abdominal and back pain, nausea, and progress to have changes in urine color, jaundice, and possibly diffuse bleeding due to coagulopathy .[emdocs.net]

Workup

The hemolytic transfusion reaction is accompanied by hemolysis, therefore the physician should order tests that highlight its presence [5]. The first step is to retype patient and donor blood and inspect patient urine and blood. Pink, red, brown or yellow color of plasma suggests hemolysis and hemoglobinemia, while red urine after centrifugation signifies hemoglobinuria. The Coombs test must follow. The direct test will be found positive. If the polyspecific direct antiglobulin test is positive, monospecific tests and antibody elution tests should be performed in order to identify the antibody involved. The antiglobulin exam becomes positive several days after the transfusion in case a delayed hemolytic reaction is present, therefore a sample of the transfused blood must be kept in the laboratory for at least 10 days [6]. The patient's hemoglobin value will diminish again 1 or 2 weeks after the transfusion of incompatible blood. At that time, increased reticulocyte levels and spherocytes may also be noticed.

Other examinations that prove hemolysis are the reduction of the plasma haptoglobin and hemopexin concentration, as well as an increase in the lactate dehydrogenase and bilirubin levels. Unfortunately, none of these markers are specific for hemolysis, but their combined presence is a strong indicator of the condition. Additional recommended tests include the prothrombin time, activated partial thromboplastin time, D- dimers, platelet count and fibrinogen levels, that help diagnose disseminated intravascular coagulation. The renal function must be closely monitored.

If no incompatibilities are demonstrated, but the patient has the complaints described above, the blood bag must be tested for hemolysis, since the administration of hemolyzed blood may induce these symptoms. Other hemolysis causes should also be searched for in case no explanation is found by conventional methods [7] [8].

Haptoglobin Decreased
  • The level of lactate dehydrogenase rose to 1257, the plasma hemoglobin rose to 16 mg per dL, and the haptoglobin decreased to CONCLUSION: Although Cromer system antibodies have generally not been proven to be clinically significant in transfusion therapy[ncbi.nlm.nih.gov]

Treatment

  • However, such treatment may be insufficient. Early diagnosis might make it possible to implement specific treatments in some cases, thereby avoiding the need for secondary transfusion. Diagnosis is dependent on the knowledge of the medical staff.[ncbi.nlm.nih.gov]
  • The transplantation was followed by treatment with cyclosporin A, methotrexate, and prednisone.[ncbi.nlm.nih.gov]
  • We report 2 children with sickle cell anemia who were diagnosed with DHTR and experienced a subsequent neurologic event in the course of treatment with corticosteroids.[ncbi.nlm.nih.gov]
  • These cases demonstrate the characteristics of the reactions, the significant risks involved, and the principles useful in diagnosis and treatment.[ncbi.nlm.nih.gov]
  • A 22-year-old female patient with a diagnosis of β thalassemia and sickle cell anemia commenced a routine exchange transfusion of 5 units of red blood cells (RBCs) in the apheresis unit as part of her regular treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Diuresis induced by an infusion of normal saline until the intense red color of hemoglobinuria ceases is usually adequate treatment. [8] Prognosis [ edit ] The major complication is that the hemoglobin, released by the destruction of red blood cells,[en.wikipedia.org]
  • Prognosis The disease responds to corticosteroids, and may be followed by remission, but usually runs a chronic course with intermittent exacerbations. The documents contained in this web site are presented for information purposes only.[orpha.net]
  • Available at Busch O et al. (1993) Blood transfusions and prognosis in colorectal cancer.[link.springer.com]
  • In general, TRALI has a favorable prognosis with mortality ranging between 5-10% 14 . Despite its prognosis, a significant number of patients (70-90%) require mechanical ventilation 11 .[emdocs.net]
  • Transfusion-Related Acute Lung Injury (TRALI) Definition and Epidemiology Clinical Presentation and Laboratory Findings Pathophysiology Diagnosis, Treatment, and Prognosis Prevention of Transfusion-Related Acute Lung Injury (TRALI) Which type of antibodies[medialabinc.net]

Etiology

  • Etiology and Pathophysiology Acute hemolytic transfusion reactions (AHTRs) When ABO-incompatible blood is transfused, donor erythrocytes are destroyed by the recipient’s preformed antibodies, causing intravascular hemolysis.[unboundmedicine.com]
  • When a hemolytic reaction is suspected, immediate action must be taken to determine its etiology and minimize its consequences. Lavender top tube of blood should be centrifuged and the plasma examined for hemoglobin.[clinlabnavigator.com]
  • Etiology Mixed AIHA can be idiopathic or secondary, mainly associated with systemic lupus erythematosus (SLE) and lymphoma.[orpha.net]
  • The exact etiology is unclear. However, the most accepted hypothesis is that a patient who is negative for human platelet antigen 1a (HPA1a) develops alloantibodies due to exposure to HPA1a antigen from the fetus during pregnancy.[merckmanuals.com]

Epidemiology

  • Epidemiology [ edit ] In the USA in 2011 there were 48 episodes of acute hemolysis due to a mismatch in ABO blood type (1 in 495,207 blood components transfused) and 168 episodes of hemolysis due to other causes (1 in 124,525 blood components transfused[en.wikipedia.org]
  • Geriatric Considerations Higher risk of complications among the elderly Epidemiology Frequency of immunologic reaction per unit of blood Allergic: 1:100 Febrile: 1:100 Delayed hemolytic: 1:1,600 Acute hemolytic: 1:50,000 Fatal hemolytic reaction: 1:500,000[unboundmedicine.com]
  • Epidemiology and physiopathology of delayed hemolytic transfusion reaction in sickle cell disease patients Sickle cell disease (SCD) is the most frequent inherited disorder in France, where it predominantly affects patients from Africa and West Indies[agence-nationale-recherche.fr]
  • Summary Epidemiology Mixed AIHA occurs in less than 10% of cases of AIHA, whose annual incidence is between 1/35,000-1/80,000 in North America and Western Europe. Clinical description Mixed AIHA can occur at any age but is rare in children.[orpha.net]
  • Transfusion-Related Acute Lung Injury (TRALI) Definition and Epidemiology Clinical Presentation and Laboratory Findings Pathophysiology Diagnosis, Treatment, and Prognosis Prevention of Transfusion-Related Acute Lung Injury (TRALI) Which type of antibodies[medialabinc.net]
Sex distribution
Age distribution

Pathophysiology

  • In most of our cases, no new antibody was identified, which underlines the complexity of the pathophysiology of this syndrome.[ncbi.nlm.nih.gov]
  • The incidence, pathophysiology, clinical presentation, diagnosis, and management of this syndrome are discussed.[ncbi.nlm.nih.gov]
  • We review the clinical features, pathophysiology, laboratory evaluation, and management of this complication.[ncbi.nlm.nih.gov]
  • Etiology and Pathophysiology Acute hemolytic transfusion reactions (AHTRs) When ABO-incompatible blood is transfused, donor erythrocytes are destroyed by the recipient’s preformed antibodies, causing intravascular hemolysis.[unboundmedicine.com]
  • The clinical consequences of HTRs are triggered via several pathophysiological pathways like formation of anaphylatoxins, release of cytokines causing a systemic inflammatory response syndrome, activation of the kinin system, the intrinsic clotting cascade[karger.com]

Prevention

  • DHTR recurrence was successfully prevented by rituximab administration prior transfusion, supporting the safe use of rituximab to prevent DHTR in SCD patients as a second line approach when other measures failed.[ncbi.nlm.nih.gov]
  • This case illustrates the use of ARE to limit hemolysis and prevent symptoms of a DHTR.[ncbi.nlm.nih.gov]
  • It is therefore essential to prevent, diagnose and treat this syndrome efficiently. Prevention is based principally on the attenuation of allo-immunization through the provision of extended-matched RBCs or the use of rituximab.[ncbi.nlm.nih.gov]
  • BACKGROUND: Preoperative transfusions are frequently given to prevent morbidity in nonpregnant patients with sickle cell disease.[ncbi.nlm.nih.gov]
  • It was concluded that the hazards of these transfusion reactions justify preventive measures, such as extended erythrocyte phenotyping of patients with sickle cell disease and extended phenotypic matching of transfused cells.[ncbi.nlm.nih.gov]

References

Article

  1. Yeh SP, Chang CW, Chen JC, et al. A well-designed online transfusion reaction reporting system improves the estimation of transfusion reaction incidence and quality of care in transfusion practice. Am J Clin Pathol. 2011;136(6):842-7.
  2. Fastman BR, Kaplan HS. Errors in transfusion medicine: have we learned our lesson?. Mt Sinai J Med. 2011;78(6):854-64.
  3. Squires JE. Risks of transfusion. South Med J. 2011;104(11):762-9.
  4. Vamvakas EC, Pineda AA, Reisner R, et al. The differentiation of delayed hemolytic and delayed serologic transfusion reactions: incidence and predictors of hemolysis. Transfusion. 1995;35:26–32.
  5. Beauregard P, Blajchman MA. Hemolytic and pseudo-hemolytic transfusion reactions: an overview of the hemolytic transfusion reactions and the clinical conditions that mimic them. Transfus Med Rev. 1994; 8(3):184-99.
  6. Flegel WA, Kubanek B, Northoff H. Abklärung einer Transfusionsreaktion. Dtsch Ärztebl. 1990;87:B–860–864.
  7. Strobel E, Nathrath M, Peters J, et al. Akute intravasale Hämolyse bei Clostridium-perfringens-Sepsis. Dtsch Med Wochenschr. 1994;119:375–9.
  8. Strobel E. Diagnostic importance and difficulties in testing of T-antigen activation. Infus Ther Transfus Med. 2002;29:249–52.

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Last updated: 2018-06-21 19:12