What are the treatment options for acute hemolytic transfusion reactions?

Updated: Jan 12, 2021
  • Author: S Gerald Sandler, MD, FCAP, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Management  of transfusion reactions varies according to the type of reaction. [59] Acute hemolytic reactions (antibody mediated) are managed as follows:

  • Immediately discontinue the transfusion while maintaining venous access for emergency management.

  • Anticipate hypotension, renal failure, and DIC.

  • Prophylactic measures to reduce the risk of renal failure may include low-dose dopamine (1-5 mcg/kg/min), vigorous hydration with crystalloid solutions (3000 mL/m2/24 h), and osmotic diuresis with 20% mannitol (100 mL/m2/bolus, followed by 30 mL/m2/h for 12 h).

  • If DIC is documented and bleeding requires treatment, transfusions of frozen plasma, pooled cryoprecipitates for fibrinogen, and/or platelet concentrates may be indicated.

Acute hemolytic reactions (nonantibody mediated) are managed as follows:

  • The transfusion of serologically compatible, although damaged, red blood cells (RBCs) usually does not require rigorous management.

  • Diuresis induced by an infusion of 500 mL of 0.9% sodium chloride per hour, or as tolerated by the patient, until the intense red color of hemoglobinuria ceases is usually adequate treatment.

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