Acute hemolytic transfusion reaction - wikipedia Acute hemolytic transfusion reaction This article may be too technical for most readers to understand. Please help improve it to make it understandable to non-experts, without removing the technical details. ( January 2018 ) An acute hemolytic transfusion reaction ( AHTR ) is a type of transfusion reaction that is associated with hemolysis. It occurs very soon after the transfusion, and within 24 hrs post-transfusion. It can occur quickly upon transfusing a few milliliters, or up to 1 -- 2 hours post-transfusion. It is also known as an `` immediate hemolytic transfusion reaction ''. This is a medical emergency as it results from rapid destruction of the donor red blood cells by host antibodies ( IgG, IgM ). It is usually related to ABO blood group incompatibility - the most severe of which often involves group A red cells being given to a patient with group O type blood. Properdin then binds to complement C3 in the donor blood, facilitating the reaction through the alternate pathway cascade. The donor cells also become coated with IgG and are subsequently removed by macrophages in the reticuloendothelial system ( RES ). Jaundice and disseminated intravascular coagulation ( DIC ) may also occur. The most common cause is clerical error ( i.e. the wrong unit of blood being given to the patient ). Contents 1 Epidemiology 2 Types 2.1 Intravascular haemolysis 2.2 Extravascular haemolysis 3 Signs and symptoms 4 Pathophysiology 4.1 Immune mediated 4.2 Non-immune mediated 5 Diagnosis 5.1 Differential diagnoses 6 Management 7 Prognosis 8 Epidemiology 9 References Epidemiology In the USA in 2011 there were 48 episodes of acute hemolysis due to a mismatch in ABO blood type ( 1 in 495,207 blood components transfused ) and 168 episodes of hemolysis due to other causes ( 1 in 124,525 blood components transfused ). In the UK in 2014 there were 18 episodes of hemolysis due to other causes ( 1 in 147,972 blood components transfused ). Types Acute hemolytic transfusion reactions are divided into two types. Intravascular haemolysis The most common cause of this reaction is ABO blood groups incompatibility, secondary to human errors. In this process, the donor 's red blood cells are destroyed by recipient 's preformed antibodies through the activation of complement system. Thus, the donor 's red blood cells break open and releases haemoglobin into the blood. The haemoglobin is then excreted into urine, causes haemoglobinuria. Meanwhile, haemoglobin can also pass through the liver system and process into bilirubin, which accumulates under the skin, causing jaundice. The release of red blood cell debris and the activation of complement system causes uncontrolled clotting ( disseminated intravascular coagulation ) and circulatory shock. Extravascular haemolysis In this case, the donor 's red blood cells are recognised and bound to IgG antibodies. Macrophages then recognise these IgG antibodies and engulf these red blood cells, removing the red blood cells from the blood circulation into liver and spleen. These red blood cells are then destroyed by macrophages in these organs. Anti-Rh antibodies most commonly directed this type of reaction. This process is much more controlled when compared with intravascular haemolysis. Liver has adequate capacity in processing the bilirubin. Therefore, jaundice rarely occurs. Signs and symptoms Early signs are fever, low blood pressure, anxiety, and red - colored urine. Late signs are generalized bleeding, caused by disseminated intravascular coagulation, and low blood pressure. Laboratory assessment is based on a positive Direct Antiglobulin Test ( DAT ), a decrease in serum haptoglobin, and an increase in blood levels of the enzyme lactate dehydrogenase and indirect bilirubin levels. Pathophysiology Immune mediated This may be caused by preformed IgM anti-A, anti-B or both. It may also be caused by other non-ABO IgG antibodies such as Rh, Kell, or Duffy. The former results in a severe intravascular hemolysis and the latter typically causes extravascular hemolysis. The reactions are mediated by cytokines like TNF, IL - 8, monocyte chemoattractant protein, IL - 1 etc. Non-immune mediated These occur when RBCs are damaged before transfusion, resulting in hemoglobinemia and hemoglobinuria. Clinical symptoms are nil or milder. Diagnosis Differential diagnoses Disseminated intravascular coagulation Hemolytic anemia Pulmonary edema Septic shock Management In case of antibody - mediated acute hemolytic transfusion reactions, Immediately discontinue the transfusion while maintaining venous access for emergency management. Anticipate low blood pressure, kidney failure, and DIC. Prophylactic measures to reduce the risk of renal failure may include low - dose dopamine, vigorous hydration with intravenous crystalloid solutions ( e.g., lactated Ringer 's solution or normal saline ), and osmotic diuresis with mannitol. If DIC is documented and bleeding requires treatment, transfusions of frozen plasma, pooled cryoprecipitates for fibrinogen, and / or platelet concentrates may be indicated. In case of non-antibody mediated AHR This does not require rigorous management. Diuresis induced by an infusion of normal saline until the intense red color of hemoglobinuria ceases is usually adequate treatment. Prognosis The major complication is that the hemoglobin, released by the destruction of red blood cells, may cause acute kidney failure ( also known as the `` oliguric phase '' ). About 20 deaths occur annually in the US due to AHTR. Epidemiology Acute hemolytic, immune mediated ( fatal ) - 1 per 250,000 - 600,000 Acute hemolytic, immune mediated ( nonfatal ) - 1 per 6000 - 33,000 Acute hemolytic, nonimmune - Infrequent References Jump up ^ Covin RB, Evans KS, Olshock R, Thompson HW ( 2001 ). `` Acute hemolytic transfusion reaction caused by anti-Coa ''. Immunohematology. 17 ( 2 ) : 45 -- 9. PMID 15373591. Jump up ^ Hoffbrand, A.V. ; P.A.H. Moss ; J.E. Pettit ( 2006 ). Essential Haematology : 5th Edition. Blackwell Publishing. ISBN 1 - 4051 - 3649 - 9. Jump up ^ Molthan L, Matulewicz TJ, Bansal - Carver B, Benz EJ ( 1984 ). `` An immediate hemolytic transfusion reaction due to anti-C and a delayed hemolytic transfusion reaction due to anti-Ce + e : hemoglobinemia, hemoglobinuria and transient impaired renal function ''. Vox Sang. 47 ( 5 ) : 348 -- 53. doi : 10.1111 / j. 1423 - 0410.1984. tb04138. x. PMID 6438912. Jump up ^ `` The 2011 National Blood Collection and Utilization Survey Report '' ( PDF ). Department of Health and Human Services. Retrieved 21 January 2016. Jump up ^ Bolton - Maggs, PHB ; Poles, D ; et al. ( The Serious Hazards of Transfusion ( SHOT ) Steering Group ) ( 2015 ). The 2014 Annual SHOT Report ( 2015 ) ( PDF ). SHOT. ISBN 978 - 0 - 9558648 - 7 - 2. ^ Jump up to : Laura, Dean ( 2005 ). Blood Groups and Red Cell Antigens. Bethesda, United States : National Center for Biotechnology Information. Retrieved 4 October 2017. Jump up ^ Harrison 's Principles of Internal Medicine ( 18th ed. ). p. 954. Jump up ^ `` Transfusion Reactions ''. Retrieved 19 November 2012. Jump up ^ `` Complications of Transfusion : Transfusion Medicine : Merck Manual Professional ''. Complications of surgical and medical care ( T80 -- T88, 996 -- 999 ) Transfusion reactions Transfusion hemosiderosis TRALI TACO TA - GvHD FNHTR Acute / Delayed hemolytic transfusion reaction Vaccine injury Eczema vaccinatum Other Serum sickness Malignant hyperthermia Herxheimer reaction Graft - versus - host disease Retrieved from `` https://en.wikipedia.org/w/index.php?title=Acute_hemolytic_transfusion_reaction&oldid=821817747 '' Categories : Transfusion reactions Complications of surgical and medical care Transfusion medicine Hidden categories : Wikipedia articles that are too technical from January 2018 All articles that are too technical Articles needing expert attention from January 2018 All articles needing expert attention Talk Contents About Wikipedia Add links This page was last edited on 22 January 2018, at 20 : 29. Text is available under the Creative Commons Attribution - ShareAlike License ; additional terms may apply. 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Question: what happens to the rbc in acute hemolytic reaction
Answer: rapid destruction of the donor red blood cells by host antibodies