Page 421 - Essential Haematology

Chapter 29 Blood transfusion / 407

evidence of red cell destruction and haemoglobin- and bilirubin, free haemoglobin and methaemal-

uria, jaundice and disseminated intravascular coag- bumin (see p. 76 ) estimations.
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ulation (DIC) may occur. Moderate leucocytosis 5 In the absence of positive findings, the patient s
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(e.g. 15 – 20 × 10 /L is usual. serum is examined 5 – 10 days later for red cell or

The oliguric phase In some patients with a white cell antibodies.
haemolytic reaction there is renal tubular necrosis
with acute renal failure.
Diuretic phase Fluid and electrolyte imbal- Management of p atients with m ajor
ance may occur during the recovery from acute h aemolysis
renal failure.

The principal object of initial therapy is to maintain
the blood pressure and renal perfusion. Intravenous
dextran, plasma or saline and frusemide are some-
Investigation of an i mmediate

times needed. Hydrocortisone 100 mg intrave-
t ransfusion r eaction
nously and an antihistamine may help to alleviate
If a patient develops features suggesting a severe shock. In the event of severe shock, support
transfusion reaction the transfusion should be with intravenous adrenaline 1 : 10 000 in small
stopped and investigations for blood group incom- incremental doses may be required. Further com-
patibility and bacterial contamination of the blood patible transfusions may be required in severely
must be initiated. affected patients. If acute renal failure occurs this is

managed in the usual way, if necessary with dialysis
1 Most severe reactions occur because of clerical
until recovery occurs.
errors in the handling of donor or recipient blood
specimens. Therefore it must be established that

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the identity of the recipient (from the patient s
Other t ransfusion r eactions
wristband) is the same as that on the compatibil-
ity label and that this corresponds with the actual Febrile reactions because of white cell anti-

unit being transfused. bodies Human leucocyte antigen (HLA) antibod-

2 The unit of donor blood and post - transfusion ies (see below and Chapter 23 ) are usually the result
samples of the patient s blood should be sent to of sensitization by pregnancy or a previous transfu-
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the laboratory who will: sion. They produce rigors, pyrexia and, in severe

(a) repeat the group on pre - and post - transfusion cases, pulmonary infi ltrates. They are minimized by

samples and on the donor blood, and repeat giving leucocyte - depleted (i.e. filtered) packed cells
the cross - match; (see below).
(b) perform a direct antiglobulin test on the Febrile or non - febrile non - haemolytic allergic
post - transfusion sample; reactions These are usually caused by hypersensi-

(c) check the plasma for haemoglobinaemia; tivity to donor plasma proteins and if severe can

(d) perform tests for DIC; and result in anaphylactic shock. The clinical features
(e) examine the donor sample directly for evi- are urticaria, pyrexia and, in severe cases, dyspnoea,
dence of gross bacterial contamination and facial oedema and rigors. Immediate treatment is
set up blood cultures from it at 20 and 37 ° C. with antihistamines and hydrocortisone. Adrenaline
If the clinical picture is suggestive of bacterial is also useful. Washed red cells or frozen red
infection blood cultures must be taken from cells may be needed for further transfusions if the
the patient and broad - spectrum intravenous majority of plasma - removed blood (e.g. saline,
antibodies started. adenine, glucose, mannitol (SAGM) blood) causes
3 A post - transfusion sample of urine must be reactions.
examined for haemoglobinuria. Post - transfusion circulatory overload Th e

4 Further samples of blood are taken 6 hours and/ management is that of cardiac failure. Th ese reac-

or 24 hours after transfusion for a blood count tions are prevented by a slow transfusion of packed