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Hemolytic transfusion reactions

Arthur J Silvergleid, MD
Section Editor
Steven Kleinman, MD
Deputy Editor
Jennifer S Tirnauer, MD


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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Literature review current through: Nov 2017. | This topic last updated: Mar 27, 2017.
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