Intravascular hemolytic transfusion reaction: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*High grade [[fever]], [[back pain|back]]/[[flank pain]], [[headache]], [[hypotension]], [[dyspnea]], [[pulmonary edema]], bleeding, [[renal failure]], [[hematuria]] | *High grade [[fever]], [[back pain|back]]/[[flank pain]], [[headache]], [[hypotension]], [[dyspnea]], [[pulmonary edema]], [[coagulopathy|bleeding]], [[renal failure]], [[hematuria]] | ||
*Sick and [[shock]]y | *Sick and [[shock]]y | ||
Revision as of 01:05, 1 October 2019
Background
- Occurs due to ABO incompatibility
- High mortality. 1:30 may die.
Clinical Features
- High grade fever, back/flank pain, headache, hypotension, dyspnea, pulmonary edema, bleeding, renal failure, hematuria
- Sick and shocky
Differential Diagnosis
Transfusion Reaction Types
- Acute
- Delayed
Acute allergic reaction
- Allergic reaction/urticaria
- Anaphylaxis
- Angioedema
- Anxiety attack
- Asthma exacerbation
- Carcinoid syndrome
- Cold urticaria
- Contrast induced allergic reaction
- Scombroid
- Shock
- Transfusion reaction
Evaluation
- Labs consistent with hemolysis
- Send off coombs test/direct antiglobin test
- Coomb's reagent binds RBCs with Ab on them
Management
- Stop transfusion
- Replace all tubing
- Risk of death is proportional to amount of incompatible blood received
- Maintain urine output with IVF (1-2 mL/kg/hr), mannitol, and furosemide as needed
- Treat shock with volume and vasopressors
- Treat coagulopathy with FFP