Immune hemolysis of transfused blood is one of the most feared complications of blood transfusion. It can result in multiple organ failure and death.


Timing of the hemolysis:

(1) immediate or acute - within seconds or minutes

(2) delayed - appearing over several days


Clinical findings:

(1) fever

(2) pain in flanks, abdomen, back, chest and/or infusion site

(3) chills and/or rigors

(4) hypotension or shock

(5) oliguria or anuria

(6) coagulopathy secondary to DIC, with bruising or oozing from wounds

(7) nausea and vomiting

(8) dyspnea

(9) tachycardia and/or cardiac arrhythmias

(10) malaise or feeling of distress


Laboratory findings:

(1) elevated serum LDH

(2) failure of anemia to correct

(3) free plasma hemoglobin, with pink plasma or serum

(4) decreased plasma haptoglobin

(5) hemoglobinuria with hemosiderinuria

(6) increased serum bilirubin, primarily unconjugated form

(7) increased urine bilirubin and urobilinogen

(8) prolonged PT and PTT, decreased fibrinogen, increased fibrin split products and thrombocytopenia (DIC)

(9) presence or emergence of an alloantibody or autoantibody targeting transfused cells

(10) positive direct antiglobulin test, typically with a mixed field agglutination pattern

(11) decreased red blood cell survival if donor cells are reinfused into the patient

(12) rising BUN and creatinine


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