Hemolytic transfusion reactions
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
Red blood cell (RBC) transfusion can be lifesaving for patients with severe anemia and/or bleeding. However, transfused blood is a foreign substance that has the potential to elicit an immune response, which can lead to destruction of the transfused RBCs (ie, immune hemolysis). Transfused RBCs are also susceptible to lysis from mechanical perturbations and other stresses including temperature extremes, osmotic pressure, and chemical injury. Other transfusion reactions can sometimes be mistaken for transfusion-associated hemolysis, and other forms of hemolysis can sometimes be mistakenly attributed to a transfusion. Determining whether hemolysis is present and transfusion-associated, and determining the cause of hemolysis associated with a blood transfusion, are important for the management of the immediate event and for reducing the risk of future transfusion-associated immune hemolysis.
The causes, evaluation, differential diagnosis, and management of immune hemolysis associated with blood transfusion are discussed here.
Other transfusion reactions, and the approach to the patient when the cause of a transfusion reaction is unknown, are discussed in separate UpToDate topic reviews:
●Transfusion reaction of unknown cause – (See "Approach to the patient with a suspected acute transfusion reaction".)
●Febrile nonhemolytic transfusion reaction (FNHTR) – (See "Leukoreduction to prevent complications of blood transfusion" and "Immunologic transfusion reactions", section on 'Febrile nonhemolytic reactions'.)
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- Mechanism of RBC destruction
- Site of RBC destruction (intravascular or extravascular)
- Timing of hemolysis (acute or delayed)
- ACUTE HEMOLYTIC REACTIONS
- Clinical presentation of AHTR
- Evaluation and immediate management of AHTR
- Differential diagnosis of AHTR
- - Other acute transfusion reactions
- - Non-immune hemolysis from RBC injury
- - Intrinsic defect in transfused cells
- - Exacerbation or discovery of hemolysis unrelated to the transfusion
- DELAYED HEMOLYTIC REACTIONS
- Clinical presentation of DHTR
- Evaluation of DHTR
- Differential diagnosis of DHTR
- Management of DHTR
- SOCIETY GUIDELINES
- SUMMARY AND RECOMMENDATIONS