Intravascular hemolytic transfusion reaction: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*High grade fever, 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 | *Sick and [[shock]]y | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*Labs consistent with hemolysis | *Labs consistent with [[hemolytic anemia|hemolysis]] | ||
*Send off coombs test/direct antiglobin test | *Send off coombs test/direct antiglobin test | ||
**Coomb's reagent binds RBCs with Ab on them | **Coomb's reagent binds RBCs with Ab on them | ||
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*Treat shock with volume and [[vasopressors]] | *Treat shock with volume and [[vasopressors]] | ||
*Treat coagulopathy with [[FFP]] | *Treat coagulopathy with [[FFP]] | ||
*Consider IV [[methylprednisolone]] | |||
==Disposition== | ==Disposition== | ||
*Admission | |||
**Most frequently to ICU | |||
==See Also== | ==See Also== | ||
Latest revision as of 17:45, 17 April 2024
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
- Consider IV methylprednisolone
Disposition
- Admission
- Most frequently to ICU