Transfusion reactions and massive transfusion: Case

Immediate management of the reaction

The transfusion is stopped at once and the intravenous line is kept open with normal saline, the airway, the breathing and the circulation are checked, and oxygen is given. The identity of the child, the wristband and the unit label are checked against the paperwork at the bedside, and the blood bank confirmation that the unit was collected for another child of the same surname identifies the root cause as a clerical error, the commonest cause of the ABO mismatch. The unit, the giving set and fresh blood samples are returned to the blood bank with a report, blood is taken for a full blood count, a group and antibody screen, a coagulation screen, a direct antiglobulin test and urea and electrolytes, and the urine is dipped for haemoglobin. The boy is managed in a high-dependency or intensive care setting, because the intravascular haemolysis threatens the renal failure and the disseminated intravascular coagulation. ^[3][11]

The boy is resuscitated with generous intravenous fluids to maintain the urine output and the renal perfusion, the blood pressure is supported with fluids and vasopressors as the shock demands, and the coagulopathy is treated with blood components as guided by the coagulation tests. The direct antiglobulin test confirms that antibody or complement has coated the transfused red cells, the repeat group and antibody screen identifies the ABO mismatch, and the fall in haemoglobin with the rise in lactate dehydrogenase and bilirubin and the haemoglobinuria confirm the intravascular haemolysis. The mechanism is the binding of the preformed immunoglobulin M antibody to the transfused A or B antigen, the complement activation and the destruction of the red cells within the blood vessel. ^[3][4]