Hemolytic transfusion reaction

Sickle cell hemolytic transfusion reaction syndrome is a unique problem in SCD patients. Owing to alloimmunization, an acute or delayed transfusion reaction may occur. Delayed reactions typically occur 5 to 20 days after transfusion. Alloantibodies and autoantibodies resulting from previous... 

Autoantibodies as a Cause of Acquired Hemolytic Anemia and Hemolytic Transfusion Reactions Biologic Test with Bovine Red Cells, Ann. Internal Med. (1956) 44,221. 

Blood transfusion is frequently associated with mild allergic reactions more serious hemolytic transfusion reactions, transfusion-related acute respiratory distress syndrome, and even fatal acute hemolytic transfusion reactions are rare but do exist. Finally, administrative errors remain one of the main causes of transfusion-related morbidity and mortality. 

Favorable results of exchange transfusion in a variety of diseases in adults, for example sickle cell disease, severe clotting disorders, hepatic failure, and acute hemolytic transfusion reactions, have been published (1). Today, however, machine apheresis procedures are more effective and safer for patients requiring exchange of cellular elements or plasma. Exchange transfusion is the most effective therapeutic procedure in the treatment of hemolytic disease of the newborn. Bilirubin removal prevents damage to the central nervous system caused by hyperbilirubinemia. In addition, sensitized erythrocytes are replaced by normally surviving cells and anemia is corrected. 

Hemolysis mediated by immune reactions is usually avoided by routine antibody screening and crossmatching methods. Improved pre-transfusion testing has resulted in a significant decrease in the incidence of hemolytic transfusion reactions, although there are examples of transfusion reactions having occurred where no antibody was detectable either before or after transfusion (53). 

When the signs and symptoms of a hemolytic transfusion reaction occur more than 24 hours after transfusion, the reaction is classified as a delayed reaction (60-62). It is estimated that up to 0.025% of recipients may well be at risk of delayed transfusion reactions (1) however, in one study only 1 in 10 668 transfused units cause delayed hemolysis. The severity of this type of reaction varies widely. Many of these reactions are so mild that they remain unnoticed only a few are severe or fatal. Almost all patients with this type of complication have a history of previous transfusion and/or pregnancy, which has made sensitization possible. The symptoms comprise fever, chills, anemia, hemoglobinemia, hemoglobinuria, and reticulocytosis. Renal insufficiency can occur and the direct antiglobulin test is positive. 

Passive transfer of allo-antibodies present in donor plasma can also cause hemolytic transfusion reactions. Low-titer erythrocjde antibodies in donor blood are considered to be relatively harmless, especially when plasma-reduced or concentrated eiythrocytes are transfused in a recipient whose cells carry the relevant antigen. A comphcation of this type provoked by high-titer anti-E antibody has been described (90). Likewise, a hemolytic transfusion reaction occurred in a Kell-negative adult when anti-KeU contained in the plasma of a unit of whole blood reacted with Kell-positive cells transfused 4 weeks before (91). 

Greenwalt TJ. Pathogenesis and management of hemolytic transfusion reactions. Semin Hematol 1981 18(2) 84-94. 

Seyfried H, Walewska I. Immune hemolytic transfusion reactions. World J Surg 1987 ll(l) 25-9. 

Glicher RO. Immune hemolytic transfusion reactions and pseudohemolytic transfusion reactions. Plasma Ther Transfus Technol 1985 6 7. 

Harrison CR, Hayes TC, Trow LL, Benedetto AR. Intravascular hemolytic transfusion reaction without detectable antibodies A case report and review of htera-ture. Vox Sang 1986 51(2) 96-101. 

Lee EL, Bennett C. Anti-Cob causing acute hemolytic transfusion reaction. Transfusion 1982 22(2) 159-60. 

Molthan L. Intravascular hemolytic transfusion reaction due to anti-Vw + Mia with fatal outcome. Vox Sang 1981 40(2) 105-8. 

Moore SB, TasweU HF, Pineda AA, Sonnenberg CL. Delayed hemolytic transfusion reactions. Evidence of the need for an improved pretransfusion compatibility test. Am J Clin Pathol 1980 74(l) 94-7. 

Patten E, Reddi CR, Riglin H, Edwards J. Delayed hemolytic transfusion reaction caused by a primary immune response. Transfusion 1982 22(3) 248-50. 

Boyland IP, Mufti GJ, Hamblin TJ. Delayed hemolytic transfusion reaction caused by anti-Fyb in a splenecto-mized patient. Transfusion 1982 22(5) 402. 

Chandeysson PL, Flye MW, Simpkins SM, Holland PV. Delayed hemolytic transfusion reaction caused by anti-Pl antibody. Transfusion 1981 21(l) 77-82. 

Diamond WJ, Brown FL Jr, Bitterman P, Klein HG, Davey RJ, Winslow RM. Delayed hemolytic transfusion reaction presenting as sickle-cell crisis. Ann Intern Med 1980 93(2) 231. ... 

Rosenfield RE. Two types of delayed hemolytic transfusion reactions. Transfusion 1985 25(2) 182-3. 

HTLC HTLV III HTN HTP HTR HTVD HUIFM HUR HUS HV H V HW hwb Hx Hz HZ HZO human T-cell leukemia virus human T-cell lymphotrophic virus type III hypertension House-Tree-Person test acute hemolytic transfusion reaction hypertensive vascular disease human leukocyte interferon meloy hemolytic uremic syndrome hemolytic uremic syndrome hallux valgus has voided hemigastrectomy and vagotomy heparin well housewife hot water bottle history hospitalization Hertz herpes zoster herpes zoster ophthalmicus... 

Hemolytic transfusion reaction involving administration of blood products having major blood group incompatibilities... 

Gupta S, Piefer CL, Fueger JT, Johnson ST, Punzalan RC. Trimethoprim-induced immune hemolytic anemia in a pediatric oncology patient presenting as an acute hemolytic transfusion reaction. Pediatr Blood Cancer 2010 55(6) 1201-3. 

Erythrocyte transfusion can be followed by a hemolytic transfusion reaction, especially in the context of emergency release before routine blood bank testing [17 j. 

Hemolytic transfusion reactions occur in 3% of all erythrocyte transfusions in patients with sickle cell disease. Most occur 4-14 days after transfusion in patients with alloimmunization from a previous transfusion. 

Goodell PP, Uhl L, Mohammed M, Powers AA. Risk of hemolytic transfusion reactions following emergency-release RBC transfusion. Am J Clin Pathol 2010 134(2) 202-6. 

Adverse events related to transfusion of blood components have been reported, including febrile non-hemolytic transfusion reactions, mild febrile reactions, acute and delayed hemolytic transfusion reactions, transfusion-related acute lung injury (TRALl), anaphylactic and other allergic reactions, graft-versus-host disease (GvHD), transfusion-associated circulatory overload (TACO), viral infections, post-transfusion bacteremia, transfusion-associated sepsis (TAS), hemosiderosis, post-transfusion purpura, and new allo-antibody formation [18 , 19 ]. Whole blood, erythrocytes, leukocytes, platelets, and plasma for transfusion (fresh frozen plasma, FFP) are involved. Quite a number of these adverse effects, such as TRALl, TACO, TAS, and allergic/anaphylactic reactions can be difficult to evaluate. 

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