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Hemolytic transfusion reaction

Blood 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 allergic transfusion reactions that do not cause hemolysis.

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 other factors to identify blood cells, 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 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.

Most of the time, a blood transfusion between compatible groups (such as O+ to O+) does not cause a problem. 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, causing them to burst.

Today, all blood is carefully screened. Transfusion reactions are rare.

Symptoms

Symptoms may include any of the following:

Symptoms of a hemolytic transfusion reaction most often appear during or right after the transfusion. Sometimes, they may develop after several days (delayed reaction).

Exams and Tests

This disease may change the results of these tests:

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 may 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)

Outcome depends on how severe the reaction is. The disorder may disappear without problems. Or, it may be severe and life threatening.

Possible Complications

Complications may include:

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 of 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. The mixture is checked under a microscope for signs of antibody reaction.

Before the transfusion, your provider will usually check again to make sure you are receiving the right blood.

References

Goodnough LT. Transfusion medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 177.

Hall JE. Blood types; transfusion; tissue and organ transplantation. In: Hall JE, ed. Guyton and Hall Textbook of Medical Physiology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 36.

Savage W. Transfusion reactions to blood and cell therapy products. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 119.

  • Surface proteins causing rejection

    Surface proteins causing rejection - illustration

    A complication of blood transfusion where there is an immune response against the transfused blood cells.

    Surface proteins causing rejection

    illustration

    • Surface proteins causing rejection

      Surface proteins causing rejection - illustration

      A complication of blood transfusion where there is an immune response against the transfused blood cells.

      Surface proteins causing rejection

      illustration

    Tests for Hemolytic transfusion reaction

     
     

    Review Date: 1/29/2019

    Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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