Analytic Reviews : Hemolytic Transfusion Reactions: A Review of Mechanisms, Sequelae, and Management

Abstract

The transfusion of blood and blood products is an im portant therapeutic procedure, but it is associated with several potentially serious adverse effects. Among these complications are hemalytic reactions, which in most cases result from the interaction between donor red cell antigens and recipient plasma antibodies. Clinical mani festations and sequelae are largely determined by the physical and immunological characteristics of the anti gens and antibodies. Early recognition may be difficult in the anesthetized or intensively monitored patient. Acute hemolytic reactions are responsible for significant morbidity and mortality and may lead to life-threatening shock, disseminated intravascular coagulation, and renal failure. Fortunately, fatal hemolytic transfusion reactions are rare; they usually result from clerical errors. Proper diagnosis and management requires sound clinical judg ment, thorough laboratory investigation, and timely therapeutic intervention.

Acute hemolytic transfusion reaction, a paradigm of the systemic inflammatory response: new insights into pathophysiology and treatment

“…In view of this potentially protective effect on kidney function, an infusion of dopamine (1-5 pg/kg/min) should be considered, even in the absence of need for blood pressure support. 35 The use of heparin to prevent DIC has long been a controversial issue. Since the majority of serious HTRs take place in surgical operating rooms and intensive care ~n i t s ,~~.~~ where bleeding may already be a significant problem, the use of heparin can pose significant hazards.…”

Hemolytic Transfusion Reactions: Acute and Delayed

“…17 If renal failure ensues, however, dialysis should be initiated promptly. 17 If renal failure ensues, however, dialysis should be initiated promptly.…”

How Safe Are Transfusions? Measures to Increase Safety

“…Because there is a growing consensus of the importance of informing patients of the potential adverse effects of transfusion, the article by Capon and Sacher [1] in this issue of the Journal is timely in its thorough review of both acute and delayed hemolytic transfusion reactions. The immunological risks of transfusion have long been recognized.…”