Hemolytic Transfusion Reaction
This occurs when a unit of blood mismatched for the ABO or Rh factors is given to a patient. The ABO factor determines what blood type you are and the Rh factor determines if you possess or lack that molecule on the membranes of your red blood cells. For example, if are blood type B- you can receive type B or type O blood (the universal donor) but not type A blood and you should not
receive Rh + blood.
Hemolytic transfusion reactions can occur when as little as 10 cc of mismatched blood is given. The reaction causes an immediate and severe disturbance in the clotting and bleeding pathways called disseminated intravascular coagulation or DIC. The mortality rate is 35% and in patients that survive there is often kidney failure from acute tubular necrosis.
The patient usually reports fever, chills, chest pain, back or flank pain, shortness of breath or dyspnea, hypotension, and red-tinged urine from the breakdown of red blood cells in the urine or hemoglobinuria. If the patient is being operated on this reaction is often detected by sudden and diffuse bleeding from a previously non-bleeding operative field.
The treatment is to emergently stop the transfusion, give generous intravenous fluids, increase the blood pressure if needed with drugs to cause arterial vasoconstriction and improve the pumping of the heart (inotropes), give plasma products to reduce the hemorrhage, increase the urine output with diuretics to flush the kidneys, and monitor the patient in the intensive care unit.
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