Handling a transfusion haemolytic reaction

Haemolytic transfusion reactions (HTRs) may be immediate/acute (AHTR) usually due to immune ABO incompatibility or delayed (DHTR) seen days to weeks following transfusion and caused by an anamnestic immune response to red cell antigens (Kidd, Rh, Duffy and others). AHTR may cause severe morbidity and mortality even if recognized early. Presently, there is no therapy that can reliably treat the effects of acute haemolysis. Therefore, RBC (and other blood components) should be transfused only if clinically indicated. Strict adherence to guidelines and SOP's is essential for prevention of this avoidable severe complication. Awareness, close observation of patients receiving transfusion, early recognition of a transfusion reaction, prompt cessation of transfusion and appropriate supportive care are essential to minimize morbidity and mortality. Factors influencing the outcome of HTRs include antibody and antigen characteristics as well as patient age and comorbidities. DHTRs are more frequent in patients with sickle cell disease (SCD), thalassaemia and haematological conditions such as autoimmune haemolytic anaemia (AIHA) and myelodysplastic syndromes (MDS). In these patients, distinction between haemolysis caused by alloantibodies or autoantibodies is challenging, especially if hyperhaemolysis is present. Investigation of HTRs should include all aspects of the transfusion chain – administrative, clinical and laboratory. In patients in whom the blood bank laboratory cannot iden...
Source: ISBT Science Series - Category: Hematology Authors: Tags: Invited Review Source Type: research