Clinical Presentation of Haemolytic Transfusion Reactions

Abstract

Haemolytic transfusion reactions can be defined as the occurrence after transfusion of measurably increased destruction of red cells, of donor or recipient, by alloantibodies. They may be acute (occurring within 24 hours of transfusion) or delayed (when signs of red cell destruction do not occur until 4 to 10 days after transfusion). The severest signs and symptoms of acute reactions follow intravascular red cell lysis and progress to anaemia, fever, haemoglobinuria and jaundice. The subjective responses of pain, restlessness, nausea, skin flushing, dyspnoea and shock are mediated by cleavage products of complement (C3a, C5a) activated by red cell antigen-antibody reaction. The bleeding and renal failure complications that follow are multi-factoral in aetiology but also stem from the activation of intravascular clotting and from the vasomotor disturbances following histamine and kinin release.

Successful use of eculizumab for treatment of an acute hemolytic reaction after ABO‐incompatible red blood cell transfusion

“…Acute intravascular hemolysis is a severe complication of transfusion therapy, which may result in major morbidity or death. 1,4 Both the release of anaphylatoxins during the activation of the complement cascade and the release of intracellular components and cell fragments are thought to cause the major part of the clinical signs and symptoms. 2 Eculizumab inhibits the cleavage of C5, 13 thereby preventing the release of the anaphylatoxin C5a and the formation of the MAC, which finally lyses the attacked cell.…”

“…Histamine causes contraction of smooth muscle cells and increases the permeability of blood vessels . A substantial part of the clinical signs and symptoms of an acute hemolytic transfusion reaction is thought to be mediated by C3a and C5a . Activation of the terminal complement cascade leads to the formation of the membrane attack complex (MAC), which can cause severe intravascular hemolysis.…”

“…3 A substantial part of the clinical signs and symptoms of an acute hemolytic transfusion reaction is thought to be mediated by C3a and C5a. 4 Activation of the terminal complement cascade leads to the formation of the membrane attack complex (MAC), which can cause severe intravascular hemolysis. Intravascular hemolysis may result in renal failure and disseminated intravascular coagulation.…”

Blood conservation in cardiac surgery

“…Patients have usually been pre-sensitised to a RBC antigen either by child birth or previous transfusion 42 . Clinical features include a gradually falling [Hb], jaundice and occasionally haemoglobinuria or renal failure 47 . The diagnosis can be confirmed by the use of direct antiglobulin testing (DAT).…”

Haematological Disorders Responsible for Maternal Bleeding in Late Pregnancy

“…Platelet-specific antibodies producing 'posttransfusion purpura': Platelets share HLA Ags with leucocytes so that sensitisation to platelet-specific Ags may cause platelet injury. 30…”