Transfusion Hemolysis


Transfusion Hemolysis, Hemolytic Transfusion Reaction, Blood Transfusion Reaction, ABO Incompatibility, Red Blood Cell Type 2 Hypersensitivity Reaction

  • Epidemiology
  1. Incidence: Up to 5 per 50,000 transfusions
  2. ABO incompatible transfusions are rare (213 events, and 24 deaths between 1996 and 2007)
    1. Vamvakas (2009) Blood 113(15): 3406-17 [PubMed]
  • Pathophysiology
  1. IgM or IgG Antibody-mediated Red Blood Cell destruction
  2. Type 2 Hypersensitivity Reaction
  3. Human error in type and cross match process is the most common cause of reaction
  • Types
  1. Intravascular Hemolytic Transfusion Reaction (Intravascular HTR)
    1. Major incompatibility: ABO
    2. Immediate and massive Hemolysis (acute, within 24 hours of transfusion)
    3. Group A Blood (AA or AO) patients have A-Antigens and Anti-B Antibody that reacts to Group B Blood Antigens
    4. Group B Blood (BB or BO) patients have B-Antigens and Anti-A Antibody that reacts to Group A Blood Antigens
    5. Group O Blood patients have no Antigens, but Anti-A and B Antibody that reacts to Group A and B Blood Antigens
    6. Group AB Blood patients have A and B Antigens, but no Antibody to react to major Antigens
      1. Group AB Blood is considered universal blood recipients (will not react to A, B or O Blood)
      2. Group O Blood is considered universal blood donor (can be given to A, B or O Blood Types without reaction)
  2. Extravascular Hemolysis (Extravascular HTR)
    1. Minor incompatibility: Rh, xKell, xDuffy, xKid
    2. Delayed RBC destruction in reticuloendothelial system (>24 hours after transfusion)
  • Signs
  • Intravascular Hemolysis (Major Incompatibility)
  • Signs
  • Extravascular Hemolysis (Minor Incompatibility)
  1. Less severe then Intravascular Hemolysis
  2. Malaise
  3. Fever
  4. Shock and Renal Failure are rare
  5. Initially red cell survival normal
  • Differential Diagnosis
  1. See Transfusion Reaction
  2. Non-Immune Hemolysis due to problem with storage or administration
    1. Results in Hemolysis due to physical factors (osmotic, heat, mechanical factors)
  • Management
  1. Avoid further transfusions if possible
  2. Replace Coagulation Factors as needed
  3. Supportive care
  4. Manage shock and Renal Failure