Background
Transfusion of red blood cell (RBC) products carries considerable risk for adverse reactions, including life-threatening hemolytic reactions.
Objective
To report the occurrence and investigation of life-threatening acute transfusion reactions with hemolysis in dogs likely related to inappropriate blood product storage.
Animals
Four dogs with acute transfusion reactions and other recipients of blood products.
Methods
Medical records were reviewed from 4 dogs with suspected acute hemolytic transfusion reactions after receiving RBC products at a veterinary clinic over a 1-month period. Medical records of other animals receiving blood products in the same time period also were reviewed. Blood compatibility and product quality were assessed, subsequent transfusions were closely monitored, and products were diligently audited.
Results
During or immediately after RBC product transfusion, 4 dogs developed hemolysis, hemoglobinuria, or both. Two dogs died and 1 was euthanized because of progressive clinical signs compatible with an acute hemolytic transfusion reaction. Blood type and blood compatibility were confirmed. RBC units from 2 blood banks were found to be hemolyzed after storage in the clinic’s refrigerator; no bacterial contamination was identified. After obtaining a new refrigerator dedicated to blood product storage, the problem of hemolyzed units and acute transfusion reactions with hemolysis completely resolved.
Conclusions
Acute life-threatening transfusion reactions can be caused by inappropriate storage of RBC products. In addition to infectious disease screening and ensuring blood-type compatibility, quality assessment of blood products, appropriate collection, processing, and storage techniques as well as recipient monitoring are critical to provide safe, effective transfusions.
Summary.
The effect of various inhibitors on autohaemolysis was investigated. Inhibitors of the sodium pump, pentose phosphate pathway, anaerobic glycolysis, or ATP synthesis and loose haemoglobin ligands had little effect. Azide was a powerful haemolytic agent, completely counteracted by glucose. Heinz bodies were seen in the cell after azide haemolysis. Fluoride had a special effect causing greater haemolysis when it was measured after 24 hr than when the cells were left undisturbed for 48 hr. From these data a working hypothesis was deduced that haemolysis seen with the autohaemolysis test requires participation of altered haemoglobin. Cells from patients with pyruvate kinase deficiency have a haemolysis pattern that fits that hypothesis making the older theories of ATP depletion as the mechanism of cell instability less tenable.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.