Hematology and Oncology Book

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Immune Transfusion ReactionAka: Transfusion Hemolysis

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  1. See Also
    1. Non-Immune Transfusion Reaction
  2. Types
    1. Intravascular Hemolysis
      1. Major incompatibility: ABO
      2. Immediate and massive Hemolysis
    2. Extravascular Hemolysis
      1. Minor incompatibility: Rh, xKell, xDuffy, xKid
      2. Delayed RBC destruction in reticuloendothelial
  3. Signs of Intravascular Hemolysis (Major Incompatibility)
    1. Rapid and massive Hemolysis to shock state
    2. Restlessness or Anxiety
    3. Flushing
    4. Chest Pain
    5. Back pain
    6. Tachypnea
    7. Tachycardia
    8. Nausea
    9. Renal Failure
    10. Coagulopathy (Disseminated Intravascular Coagulation)
  4. Signs of Extravascular Hemolysis (Minor Incompatibility)
    1. Less severe then Intravascular Hemolysis
    2. Malaise
    3. Fever
    4. Shock and Renal Failure are rare
    5. Initially red cell survival normal
  5. Labs
    1. Document Hemolysis
      1. Plasma Hemoglobin and Hematocrit
      2. Urine Hemoglobin
      3. Haptoglobin
      4. Bilirubin
    2. Check Renal Function
      1. Urinalysis
      2. Blood Urea Nitrogen (BUN)
      3. Creatinine
    3. Check coagulation status
      1. Platelet Count
      2. ProTime
      3. Partial Thromboplastin Time (PTT)
  6. Management
    1. Avoid further transfusions if possible
    2. Replace Coagulation Factors as needed
    3. Manage shock and Renal Failure

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