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Transfusion reaction - hemolytic

Blood transfusion reaction

 

A hemolytic transfusion reaction is a serious complication that can occur after a blood transfusion. The reaction occurs when the red blood cells that were given during the transfusion are destroyed by the person's immune system.

There are other types of allergic transfusion reactions that do not cause hemolysis.

Causes

 

Blood is classified into four different types: A, B, AB, and O.

Another way blood cells may be classified is by Rh factors. People who have Rh factors in their blood are called "Rh positive." People without these factors are called "Rh negative." Rh negative people form antibodies against Rh factor if they receive Rh positive blood.

There are also other factors to identify blood cells, in addition to ABO and Rh.

Your immune system can usually tell its own blood cells from those of another person. If you receive blood that is not compatible with your blood, your body produces antibodies to destroy the donor's blood cells. This process causes the transfusion reaction. Blood that you receive in a transfusion must be compatible with your own blood. This means that your body does not have antibodies against the blood you receive.

Most of the time, a blood transfusion between compatible groups (such as O+ to O+) does not cause a problem. Blood transfusions between incompatible groups (such as A+ to O-) cause an immune response. This can lead to a serious transfusion reaction. The immune system attacks the donated blood cells, causing them to burst.

Today, all blood is carefully screened. Transfusion reactions are rare.

 

Symptoms

 

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. Sometimes, they may develop after several days (delayed reaction).

 

Exams and Tests

 

This disease may change the results of these tests:

  • CBC
  • Coombs test, direct
  • Coombs test, indirect
  • Fibrin degradation products
  • Haptoglobin
  • Partial thromboplastin time
  • Prothrombin time
  • Serum bilirubin
  • Serum creatinine
  • Serum hemoglobin
  • Urinalysis
  • Urine hemoglobin

 

Treatment

 

If symptoms occur during the transfusion, the transfusion must be stopped right away. Blood samples from the recipient (person getting the transfusion) and from the donor may be tested to tell whether symptoms are being caused by a transfusion reaction.

Mild symptoms may be treated with:

  • Acetaminophen, a pain reliever to reduce fever and discomfort
  • Fluids given through a vein (intravenous) and other medicines to treat or prevent kidney failure and shock.

 

Outlook (Prognosis)

 

Outcome depends on how bad the reaction is. The disorder may disappear without problems. Or, it may be severe and life-threatening.

 

Possible Complications

 

Complications may include:

  • Acute kidney failure
  • Anemia
  • Lung problems
  • Shock

 

When to Contact a Medical Professional

 

Tell your health care provider if you are having a blood transfusion and you have had a reaction before.

 

Prevention

 

Donated blood is put into ABO and Rh groups to reduce the risk of transfusion reaction.

Before a transfusion, recipient and donor blood are tested (cross-matched) to see if they are compatible. A small amount of donor blood is mixed with a small amount of recipient blood. The mixture is checked under a microscope for signs of antibody reaction.

Before the transfusion, your health care provider will usually check again to make sure you are receiving the right blood.

 

 

Open References

References

Choat JD, Maitta RW, Tormey CA, Wu YY, Snyder EL. Transfusion reactions to blood and cell therapy products. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. Hematology: Basic Principles and Practice . 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 120.

Goodnough L. Transfusion medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 177.

 
  • Surface proteins causing rejection

    Surface proteins causing rejection - illustration

    A complication of blood transfusion where there is an immune response against the transfused blood cells.

    Surface proteins causing rejection

    illustration

    • Surface proteins causing rejection

      Surface proteins causing rejection - illustration

      A complication of blood transfusion where there is an immune response against the transfused blood cells.

      Surface proteins causing rejection

      illustration

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        Review Date: 2/13/2015

        Reviewed By: Rita Nanda, MD, Assistant Professor of Medicine, Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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