Acute hemolytic transfusion reaction

Acute hemolytic transfusion reaction

An acute hemolytic transfusion reaction (AHTR) is a type of transfusion reaction that is associated with hemolysis.

It occurs very soon after the transfusion.[1] It can occur quickly upon transfusing a few milliliters, or up to 1-2 hours post-transfusion. [2]

It is also known as an "immediate hemolytic transfusion reaction".[3]

This is a medical emergency as it results from rapid destruction of the donor red blood cells by host antibodies (IgG, IgM). It is usually related to ABO blood group incompatibility - the most severe of which often involves group A red cells being given to a patient with group O type blood. Properdin then binds to complement C3 in the donor blood, facilitating the reaction through the alternate pathway cascade. The donor cells also become coated with IgG and are subsequently removed by macrophages in the reticuloendothelial system (RES). Jaundice and disseminated intravascular coagulation (DIC) may also occur.

The most common cause is clerical error (i.e. the wrong unit of blood being given to the patient). The symptoms are fever and chills, sometimes with back pain and pink or red urine (hemoglobinuria). The major complication is that the hemoglobin, released by the destruction of red blood cells, may cause acute renal failure (also known as the "oliguric phase").

About 20 annual deaths in the US are due to AHTR.[4]

References

  1. ^ Covin RB, Evans KS, Olshock R, Thompson HW (2001). "Acute hemolytic transfusion reaction caused by anti-Coa". Immunohematology 17 (2): 45–9. PMID 15373591. 
  2. ^ Hoffbrand, A. V.; P.A.H. Moss, J.E. Pettit (2006). Essential Haematology: 5th Edition. Blackwell Publishing. ISBN 1-4051-3649-9. 
  3. ^ Molthan L, Matulewicz TJ, Bansal-Carver B, Benz EJ (1984). "An immediate hemolytic transfusion reaction due to anti-C and a delayed hemolytic transfusion reaction due to anti-Ce+e: hemoglobinemia, hemoglobinuria and transient impaired renal function". Vox Sang. 47 (5): 348–53. doi:10.1111/j.1423-0410.1984.tb04138.x. PMID 6438912. 
  4. ^ "Complications of Transfusion: Transfusion Medicine: Merck Manual Professional". http://www.merck.com/mmpe/sec11/ch146/ch146e.html#sec11-ch146-ch146d-1082. 
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