A patient undergoing general anesthesia can have a hemolytic transfusion reaction. This can go unnoticed since the patient is unable to report the typical symptoms.


Risk factors:

(1) emergency surgery

(2) massive transfusion with rapid administration of the blood

(3) failure to follow protocol for blood administration

(4) history of multiple past transfusions (increases risk of an unexpected alloantibody)


Clinical manifestations:

(1) sudden onset of hemoglobinuria (which may go unnoticed if the urine bag is covered by the surgical drapes)

(2) unexplained hypotension (which may be ascribed to another cause)

(3) diffuse coagulopathy (which may be mistaken for dilutional coagulopathy)


Reasons for a delay in diagnosis:

(1) failure to recognize the clinical manifestations

(2) ascribing the change to a different cause


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