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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