From the Guidelines
Acute hemolytic transfusion reaction (AHTR) is a potentially fatal complication of transfusion support, characterized by the rapid destruction of red blood cells due to incompatibility between the donor's and recipient's blood, which can occur within minutes to hours of a blood transfusion. This reaction is among the most challenging complications of transfusion support, particularly in patients with sickle cell disease (SCD) 1. The symptoms of AHTR include fever, chills, back pain, chest tightness, shortness of breath, hypotension, and in severe cases, shock and kidney failure.
Key characteristics of AHTR include:
- Rapid destruction of red blood cells
- Occurs within minutes to hours of a blood transfusion
- Caused by incompatibility between the donor's and recipient's blood
- Symptoms include fever, chills, back pain, and hypotension
- Can lead to severe complications, including shock and kidney failure
Management of AHTR involves:
- Immediately stopping the transfusion
- Maintaining blood pressure with IV fluids
- Administering diuretics to prevent renal failure
- Providing supportive care
- Laboratory tests will show hemoglobinuria, decreased haptoglobin, elevated bilirubin, and positive direct antiglobulin test 1.
Prevention of AHTR is crucial, and proper patient identification and blood product verification are essential to prevent clerical errors, which are the most common cause of ABO incompatibility 1. Prompt recognition and treatment of AHTR are critical, as severe reactions can be life-threatening with significant morbidity and mortality.
From the Research
Definition and Causes of Acute Hemolytic Transfusion Reaction (AHTR)
- An acute hemolytic transfusion reaction (AHTR) is a rare but potentially life-threatening complication of blood transfusion, occurring when there is an immunological incompatibility between the donor and the recipient's blood 2, 3, 4, 5, 6.
- AHTR can be caused by the transfusion of incompatible red blood cells (RBCs) or, less commonly, by the transfusion of a large volume of incompatible plasma 2.
- The reaction can occur within 24 hours of transfusion and is characterized by the destruction of red blood cells, which can lead to severe consequences such as hemolysis, acute renal failure, and disseminated intravascular coagulation 3, 4, 5, 6.
Clinical Presentation and Symptoms of AHTR
- The clinical presentation of AHTR can vary, but common symptoms include fever, flank pain, and red or dark urine 2, 4, 6.
- In some cases, the traditional triad of symptoms may not be immediately visible, especially if the patient is under anesthesia 4.
- Other symptoms of AHTR can include nausea, skin flushing, dyspnea, and shock, which are mediated by the activation of complement and the release of histamine and kinins 6.
Treatment and Management of AHTR
- The treatment of AHTR is primarily supportive, with measures aimed at managing the symptoms and preventing further complications 3, 5.
- Plasma exchange has been used as a treatment for AHTR, particularly in cases where other measures have failed 3, 5.
- In some cases, medications such as ruxolitinib may be used as part of the treatment regimen 5.
- Preventive measures, such as careful blood typing and cross-matching, are crucial in reducing the risk of AHTR 2, 5.