Acute haemolysis, DIC and renal failure after transfusion of uncross‐matched blood during trauma resuscitation: illustrative case and literature review

Fiorellino, Joseph; Elahie, Allahna; Warkentin, Theodore E.

doi:10.1111/tme.12513

Cited by 12 publications

(4 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…From a clinical view, there was no evidence for the development of HTR or any relationship between transfusion and outcome. Ultimately, our results are confirmed by several previous reports (Table 2 ) [ 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Only a few of the latter patients have developed HTR.…”

Section: Discussionsupporting

confidence: 92%

Safety of Uncrossmatched ABO-Compatible RBCs in Alloimmunized Patients with Bleeding: Data from Two Decades: Results of a Systematic Analysis in 6,109 Patients

Ringel

Schoenfeld

Bali

et al. 2021

Transfus Med Hemother

View full text Add to dashboard Cite

Introduction: Uncrossmatched ABO-compatible red blood cells (RBCs) are generally recommended in patients with life-threatening massive bleeding. There is little data regarding RBC transfusion when patients are transfused against clinically significant alloantibodies because compatible RBCs are not immediately available. Methods/Patients: All patients reviewed in this study (n = 6,109) required emergency blood transfusion and were treated at the Charité – Universitätsmedizin Berlin between 2001 and 2015. Primary uncrossmatched O Rh(D)-positive or -negative RBC units were immediately transfused prior to complete regulatory serological testing including determination of ABO group, Rhesus antigens, antibody screening, and crossmatching. Results: Without any significant change in the protocol of emergency transfusion of RBCs, a total of 63,373 RBC units were transfused in 6,109 patients. Antibody screening was positive in 413 patients (6.8%), and 19 of these patients received RBC units against clinically significant alloantibodies. None of these patients appeared to have developed significant hemolysis, and only one patient with anti-D seems to have developed signs of insignificant hemolysis following the transfusion of three Rh(D)-positive units. One patient who had anti-Jka received unselected units and did not develop a hemolytic transfusion reaction. Conclusion: Transfusion of uncrossmatched ABO-compatible RBCs against alloantibodies is highly safe in patients with life-threatening hemorrhage.

show abstract

Section: Discussionsupporting

confidence: 92%

Safety of Uncrossmatched ABO-Compatible RBCs in Alloimmunized Patients with Bleeding: Data from Two Decades: Results of a Systematic Analysis in 6,109 Patients

Ringel

Schoenfeld

Bali

et al. 2021

Transfus Med Hemother

View full text Add to dashboard Cite

show abstract

“…Of special importance in the emergency department is the emergency transfusion of non-compatible blood products, which is practiced in trauma centers worldwide. Nevertheless, there is a small but potentially serious risk of acute hemolytic transfusion reactions (<1/1000) that the clinician should be aware of [ 16 ].…”

Section: Transfusion Reactionsmentioning

confidence: 99%

Blood Transfusion Reactions—A Comprehensive Review of the Literature including a Swiss Perspective

Ackfeld

Schmutz

Guéchi

et al. 2022

JCM

View full text Add to dashboard Cite

Blood transfusions have been the cornerstone of life support since the introduction of the ABO classification in the 20th century. The physiologic goal is to restore adequate tissue oxygenation when the demand exceeds the offer. Although it can be a life-saving therapy, blood transfusions can lead to serious adverse effects, and it is essential that physicians remain up to date with the current literature and are aware of the pathophysiology, initial management and risks of each type of transfusion reaction. We aim to provide a structured overview of the pathophysiology, clinical presentation, diagnostic approach and management of acute transfusion reactions based on the literature available in 2022. The numbers of blood transfusions, transfusion reactions and the reporting rate of transfusion reactions differ between countries in Europe. The most frequent transfusion reactions in 2020 were alloimmunizations, febrile non-hemolytic transfusion reactions and allergic transfusion reactions. Transfusion-related acute lung injury, transfusion-associated circulatory overload and septic transfusion reactions were less frequent. Furthermore, the COVID-19 pandemic has challenged the healthcare system with decreasing blood donations and blood supplies, as well as rising concerns within the medical community but also in patients about blood safety and transfusion reactions in COVID-19 patients. The best way to prevent transfusion reactions is to avoid unnecessary blood transfusions and maintain a transfusion-restrictive strategy. Any symptom occurring within 24 h of a blood transfusion should be considered a transfusion reaction and referred to the hemovigilance reporting system. The initial management of blood transfusion reactions requires early identification, immediate interruption of the transfusion, early consultation of the hematologic and ICU departments and fluid resuscitation.

show abstract

“…Die genaue Frequenz akuter hämolytischer Transfusionsreaktionen außerhalb des AB0-Systems ist nicht bekannt. In einem aktuellen Fallbericht mit Literaturübersicht aus Kanada benennen Fiorellino et al die Wahrscheinlichkeit einer außerhalb des AB0-Systems unverträglichen Erythrozytentransfusion mit 0,6 % aller Notfalltransfusionen, bei denen darüber hinaus auch nur bei einem Teil der inkompatiblen Transfusionen tatsächlich eine hämolytische Transfusionsreaktion auftritt [5].…”

Section: Diskussionunclassified

Akute hämolytische Transfusionsreaktion durch ein Anti-s infolge verzögerter immunhämatologischer Diagnostik bis zum Eintritt eines hämorrhagischen Schocks

Zimmermann

Strasser

Hackstein

2019

Transfusionsmedizin

View full text Add to dashboard Cite

ZusammenfassungIm vergangenen Jahrzehnt kam es in den meisten Industrieländern, auch in Deutschland, zu tiefgreifenden Veränderungen in der klinischen Praxis der Hämotherapie. Die Indikationsstellung zur Erythrozytentransfusion erfolgt immer zurückhaltender. Der Verbrauch von Erythrozytenkonzentraten ist stark rückläufig. Gleichzeitig steigt auch die Zahl der Patienten, bei denen trotz geplanter Operation oder Intervention die präoperative bzw. präinterventionelle Bereitstellung von gekreuzten Blutkonserven unterbleibt. Wir berichten über einen 71-jährigen multimorbiden Patienten mit dilatativer Kardiomyopathie, stark reduzierter kardialer Reserve, Z. n. wenige Wochen zurückliegender Trikuspidalklappenersatz-Operation, laufender Antikoagulation mit Heparin und diagnostizierter Anämie mit Hämoglobinwerten zwischen 7 und 8 g/dl. Bei diesem Patienten kam es nach einer bereits mehrtägigen stationären Behandlung unerwartet zu einem hämorrhagischen Schock infolge einer Forrest-IIb-Blutung aus einem Ulcus duodeni. Im Rahmen der Notfallversorgung stellte sich heraus, dass jede transfusionsvorbereitende Diagnostik versäumt worden war. Die notfallmäßig bereitgestellten, ungekreuzten Erythrozytenkonzentrate der Blutgruppe 0 Rhesus-negativ lösten bei diesem Patienten eine akute hämolytische Transfusionsreaktion aus. Grund war ein zum Transfusionszeitpunkt nicht identifizierter irregulärer Antikörper gegen das Blutgruppenmerkmal s aus dem MNSs-Blutgruppensystem. Akute hämolytische Transfusionsreaktionen außerhalb des AB0-Systems sind eine seltene, dennoch grundsätzlich immer drohende Komplikation der Transfusion ungekreuzter Erythrozytenkonzentrate im lebensbedrohlichen Blutungsnotfall. Der Fall zeigt, dass der Wunsch, eine restriktive Transfusionspraxis zu befolgen, nicht dazu führen darf, im Einzelfall Konstellationen zu übersehen, die selbstverständlich die rechtzeitige Vornahme einer prätransfusionellen Diagnostik mit Blutgruppenbestimmung, Antikörpersuche und Antikörperidentifizierung erfordern. Nach unserer Meinung nimmt die Frequenz vergleichbarer Ereignisse in einem Ausmaß zu, das es nahelegt, solche Fehler im klinischen Behandlungsgeschehen nicht nur in CIRS-Systemen zu bearbeiten, sondern sie auch in den Hämovigilanzsystemen zu erfassen.

show abstract

Acute haemolysis, DIC and renal failure after transfusion of uncross‐matched blood during trauma resuscitation: illustrative case and literature review

Abstract: Although emergency transfusion of uncross-matched blood is commonly practiced at trauma centres worldwide, with low risk of acute HTR (<1/1000), our well-documented patient case demonstrates the potential for acute HTR with severe complications.

Cited by 12 publications

References 24 publications

Safety of Uncrossmatched ABO-Compatible RBCs in Alloimmunized Patients with Bleeding: Data from Two Decades: Results of a Systematic Analysis in 6,109 Patients

Safety of Uncrossmatched ABO-Compatible RBCs in Alloimmunized Patients with Bleeding: Data from Two Decades: Results of a Systematic Analysis in 6,109 Patients

Blood Transfusion Reactions—A Comprehensive Review of the Literature including a Swiss Perspective

Akute hämolytische Transfusionsreaktion durch ein Anti-s infolge verzögerter immunhämatologischer Diagnostik bis zum Eintritt eines hämorrhagischen Schocks

Contact Info

Product

Resources

About