Acute hemolysis – from ABO incompatibility; antibody mediated

•  Back pain, chills, tachycardia, fever, hemoglobinuria

•  Can lead to ATN, DIC, shock

•  Haptoglobin < 50 mg/dL (binds Hgb, then gets degraded), free hemoglobin > 5 g/dL, increase in unconjugated bilirubin

•  Tx: fluids, diuretics, HCO₃⁻, pressors, histamine blockers (Benadryl)

•  In anesthetized patients, transfusion reactions may present as diffuse bleeding

  Delayed hemolysis – antibody-mediated against minor antigens

•  Tx: observe if stable

  Nonimmune hemolysis – from squeezed blood

•  Tx: fluids and diuretics

OTHER REACTIONS

  Febrile nonhemolytic transfusion reaction – most common transfusion reaction

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