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Acute haemolytic transfusion reactions (other than ABO incompatibility)

2011–12 Data Summary (n=10)
Age Sex Day of Transfusion
0–4 years - Male 4 Week day 6
5–14 years - Female 5 Weekend 4
15–24 years - Uncategorised 1
25–34 years - Facility Location Time of Transfusion
35–44 years - Major City 9 Between 7am and 7pm 6
45–54 years 1 Inner Regional 1 Between 7pm and 7am 1
55–64 years 2 Outer Regional - Unknown 3
65–74 years 4 Remote -
75+ years 3 Very Remote -
Not specified - Uncategorised -
Clinical Outcome Severity Imputability Blood Component
Death - Excluded/Unlikely - Whole blood -
Life threatening 1 Possible - Red cells 10
Severe morbidity 3 Likely/Probable 5 Platelets -
Minor morbidity 6 Confirmed/Certain 4 Fresh Frozen Plasma -
No morbidity - Not assessable 1 Cryoprecipitate -
Outcome not available - Cryodepleted plasma -
2012–13 Data Summary (n=2)
Age Sex Day of Transfusion
0–4 years - Male - Week day 2
5–14 years - Female - Weekend -
15–24 years - Uncategorised 2
25–34 years - Facility Location Time of Transfusion
35–44 years - Major City 1 Between 7am and 7pm -
45–54 years - Inner Regional - Between 7pm and 7am -
55–64 years - Outer Regional - Unknown 2
65–74 years 1 Remote -
75+ years 1 Very Remote -
Not specified - Uncategorised 1
Clinical Outcome Severity Imputability Blood Component
Death - Excluded/Unlikely - Whole blood -
Life threatening - Possible - Red cells 2
Severe morbidity - Likely/Probable 1 Platelets -
Minor morbidity 2 Confirmed/Certain - Fresh Frozen Plasma -
No morbidity - Not assessable 1 Cryoprecipitate -
Outcome not available - Cryodepleted plasma -

Notes

  1. QLD data is unavailable for 2012–13.
  2. Sex and facility location data is unavailable for NSW.
  3. Time of transfusion data is unavailable for NSW and SA.
  4. Data is unavailable for WA.
  5. Uncategorised refers to those reports where no data was provided.

Acute haemolytic transfusion reactions (AHTR) occur by definition within 24 hours of transfusion. Diagnosis of an AHTR can be difficult, as reactions are often seen in patients with concurrent illnesses that may have other causes for their symptoms.

Adverse events attributed to transfusion of ABO incompatible components can cause AHTRs, but are categorised as incorrect blood component transfused (IBCT) as that is the key error. Transfusion of ABO incompatible components to a patient is considered a 'sentinel event' and is subject to other reporting requirements in addition to the National Haemovigilance Program.

From 2011–12 to 2012–13, there were 12 reports to the National Haemovigilance Program, with three cases of severe morbidity and one case of life threatening severity imputed as confirmed/certain. All cases were related to RBC transfusion. The National Haemovigilance Program has not gathered data on the particular red cell antibodies associated with haemolytic transfusion reactions.

Clinical recommendation

The Blood Service provides guidance on the recognition, investigation and management of anaphylactic reactions.[20]

  • When to suspect these adverse reactions?

    It characteristically begins with an increase in temperature and pulse rate.

    Symptoms may include chills, rigors, dyspnoea, chest and/or flank pain, discomfort at infusion site, sense of dread, abnormal bleeding and may progress rapidly to shock.

    Instability of blood pressure is frequently seen. Transfused patients develop oliguria, haemoglobinuria and haemoglobinaemia.

  • Usual causes?

    Acute haemolytic transfusion reactions occur at an incidence of 1:76,000 transfusions and may be associated with:

    • ABO/Rh mismatch patient antibodies to plasma proteins (such as IgG, albumin, haptoglobin, transferrin, C3, C4 or cytokines)
    • red cell alloantibodies (non-ABO) as a result of patient immunisation from previous pregnancy or transfusion
    • rare cases when Group O donor platelets with high titres of anti-A and/or anti-B are transfused to a non-Group O recipient.
  • Investigation

    Clinically assess patients for common features of haemolysis occurring within 24 hours of transfusion.

    Check clerical records, such as ABO typing of patient and unit.

    Repeat patient ABO grouping in both pre- and post-transfusion samples.

  • What to do?

    Stop transfusion immediately and follow other steps for managing suspected transfusion reactions. Seek urgent medical assistance. Maintain blood pressure and renal output.

    Induce diuresis with intravenous fluids and diuretics.

    This may become a medical emergency so support blood pressure and maintain an open airway.