Hemolytic transfusion reaction
A hemolytic transfusion reaction is a serious complication that can occur after a blood transfusion. The reaction occurs when the red blood cells that were given during the transfusion are destroyed by the person's immune system. When red blood cells are destroyed, the process is called hemolysis.
There are other types of transfusion reactions that do not cause hemolysis, such as febrile (causing fever) transfusion reactions.
Causes
Blood is classified into four different types: A, B, AB, and O.
Another way blood cells may be classified is by Rh factors. People who have Rh factors in their blood are called "Rh positive." People without these factors are called "Rh negative." Rh negative people form antibodies against Rh factor if they receive Rh positive blood.
There are also many other blood-related factors that differ among people, in addition to ABO and Rh.
Your immune system can usually tell its own blood cells from those of another person. If you receive blood that is even partially not compatible with your blood, your body produces antibodies to destroy the donor's blood cells. This process causes the transfusion reaction. Blood that you receive in a transfusion must be compatible with your own blood. This means that your body does not have antibodies against the blood you receive.
Antibodies
An antibody is a protein produced by the body's immune system when it detects harmful substances, called antigens. Examples of antigens include micr...
Read Article Now Book Mark ArticleMost of the time, a blood transfusion between compatible groups (such as O+ to O+) does not cause a problem. However, minor mismatches in blood factors can cause a reaction. It is usually mild. Blood transfusions between incompatible groups (such as A+ to O-) cause an immune response. This can lead to a serious transfusion reaction. The immune system attacks the donated blood cells, destroying them.
Today, all blood is carefully screened. Transfusion reactions are rare.
Symptoms
Symptoms may include any of the following:
- Back pain
- Bloody urine
Bloody urine
Blood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the...
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- Fainting or dizziness
- Fever
- Flank pain
Flank pain
Flank pain is pain in one side of the body between the upper belly area (abdomen) and the back.
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Symptoms of a hemolytic transfusion reaction most often appear during or right after the transfusion. Sometimes, they may develop after several days (delayed transfusion reaction).
Exams and Tests
This disease may change the results of these tests:
- Complete blood count (CBC)
Complete blood count (CBC)
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
Read Article Now Book Mark Article - Coombs test, direct
Coombs test, direct
The Coombs test looks for antibodies that may stick to your red blood cells and cause red blood cells to die too early.
Read Article Now Book Mark Article - Coombs test, indirect
- Fibrin degradation products
Fibrin degradation products
Fibrin degradation products (FDPs) are the substances left behind when clots dissolve in the blood. A blood test can be done to measure these produc...
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Haptoglobin
The haptoglobin blood test measures the level of haptoglobin in your blood. Haptoglobin is a protein produced by the liver. It attaches to a certain...
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Partial thromboplastin time
Partial thromboplastin time (PTT) is a blood test that looks at how long it takes for blood to clot. It can help tell if you have a bleeding problem...
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Prothrombin time
Prothrombin time (PT) is a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot. It measures the functio...
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Serum bilirubin
The bilirubin blood test measures the level of bilirubin in the blood. Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. Bi...
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Serum creatinine
The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys are working. Creatinine in t...
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Serum hemoglobin
Serum free hemoglobin is a blood test that measures the level of free hemoglobin in the liquid part of the blood (the serum). Free hemoglobin is the...
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Urinalysis
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
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Treatment
If symptoms occur during the transfusion, the transfusion must be stopped right away. Blood samples from the recipient (person getting the transfusion) and from the donor must be tested to tell whether symptoms are being caused by a transfusion reaction.
Mild symptoms may be treated with:
- Acetaminophen, a pain reliever to reduce fever and discomfort
- Fluids given through a vein (intravenous) and other medicines to treat or prevent kidney failure and shock
Outlook (Prognosis)
The outcome depends on how severe the reaction is. The disorder may run its course without problems. Or, it may be severe and life threatening.
Possible Complications
Complications may include:
- Acute kidney failure
Acute kidney failure
Acute kidney failure is the rapid (less than 2 days) loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your b...
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Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...
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- Shock
Shock
Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means the cells and organs do n...
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When to Contact a Medical Professional
Tell your health care provider if you are having a blood transfusion and you have had a reaction before.
Prevention
Donated blood is put into ABO and Rh groups to reduce the risk for transfusion reaction.
Before a transfusion, recipient and donor blood are tested (cross-matched) to see if they are compatible. A small amount of donor blood is mixed with a small amount of recipient blood and tested to see if transfused cells are destroyed or clumped.
Before the transfusion, your provider will usually check again to make sure you are receiving the right blood.
Reviewed By
Mark Levin, MD, Hematologist and Oncologist, Monsey, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Hall JE, Hall ME. Blood types; transfusion; and tissue and organ transplantation. In: Hall JE, Hall ME, eds. Guyton and Hall Textbook of Medical Physiology. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 36.
Schipperus MR, Wiersum-Osselton JC. Transfusion reactions to blood and cell therapy products. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 117.
Shaz BH, Hillyer CD. Transfusion medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 167.