Acute Hemolytic Transfusion Reaction

Transfusion reactions are typically caused by blood type (ABO) incompatibility. This incompatibility can occur between the recipient and blood product from the donor. What can determine how strong the reaction is the specific RBC antigens that are being targeted and the nature of the correlating phyla toxins and the number of antibodies in the blood. What happens first in an acute hemolytic transfusion reaction is the binding of the recipients’ antibodies to the antigens on the RBCs that have been transfused. Antibodies fix the complement, and this causes destruction of red blood cells in the vascular system. Activation of the complement system leads to over production of of the terminal membrane attack complexes compromising C5-C9 proteins which leads to pores being formed in the transfused blood cells which activate mast cells. Mast cells have specific receptors so that specific complement proteins connect at these points and this leads to mast cell degranulation where histamine is released. Histamine causes vessels to dilate and bronchoconstriction and release of pro-inflammatory cytokines. This is why blood pressure decreases, heart rate increases in compensation, temperature can increase and respirations can also increase. Rupture of the RBCs releases free hemoglobin which can block renal tubules in the kidneys and cause renal vasoconstriction and lead to acute tubular necrosis and renal failure, dark coloured urine was observed in the patient’s catheter bag. There are some diagnostic tests that can confirm hemolysis such as blood typing, Rh incompatibility, repeated testing can help confirm previously undetected antibodies that can be responsible for hemolysis. Conducting a renal panel will determine renal function by measuring uria, nitrogen, creatinine and electrolyte levels. An ECG can monitor heart function. Stopping the transfusion letting physician know and giving IV fluid is most important demonstrated in case study reenactment. Routine cross-match and antibody screen can assist in making sure there are no errors.

There was a lot of content to put in that 10-minute video and I thought that this group did a good job to not leave any gaps especially when introducing the pathophysiology of an acute hemolytic transfusion reaction. I found that some acronyms were introduced well into the content and others I had to investigate. I wasn’t aware that HTR was the acronym for hemolytic transfusion reaction. It would have been nice to have a further breakdown of the case study I why the patient was experiencing certain symptoms.

I appreciated the detail of the introduction of the video to the topic. I found that the beginning was very fast paced and it was hard to follow at times. It was challenging to understand everyone that was speaking in the video and I had to slow down the video and replay it at times as I missed important parts.

I would have loved if the case study was introduced verbally as well as on the screen. I would have been nice if the case study was introduced in more detail at beginning of video.

I would integrate this information into my practice by ensuring that all diagnostic tests were carried out following a transfusion reaction. Calling the physician right away, conducting a renal panel, and any other appropriate blood work and interpreting it closely can assist in determining the cause of reaction. Frequent vital signs can also assist in managing what is going on in the patient. Establishing the root of the problem and collaborating with the care team would be one take away for me as if this transfusion reaction isn’t treated quickly it can lead to severe impact such as and acute kidney injury.