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

TitleAcute haemolysis, DIC and renal failure after transfusion of uncross-matched blood during trauma resuscitation: illustrative case and literature review
Publication TypeJournal Article
Year of Publication2018
AuthorsFiorellino J, AL E, Warkentin TE
Date PublishedFeb
Keywordsalloimmune haemolytic transfusion reaction, disseminated intravascular coagulation, emergency transfusion, renal failure, uncross-matched blood
Abstract

AIMS/OBJECTIVES:

The aims of this study were to report a patient with acute haemolytic transfusion reaction (HTR) after transfusing uncross-matched red blood cell (RBC) units and to identify the frequency of this complication.
BACKGROUND:

Uncross-matched RBC units are commonly transfused in emergencies, but the frequency of acute HTR is unknown.
METHODS:

We describe a male stabbing victim who received three units of uncross-matched RBC units complicated by acute intravascular HTR, disseminated intravascular coagulation (DIC) and renal failure. We identified 14 studies evaluating the frequency of acute HTR post-emergency transfusion of uncross-matched RBC units.
RESULTS:

Acute HTR was shown by haemoglobinuria, free-plasma haemoglobin and methemalbumin, with anti-K and anti-Fya eluted from recipient red cells; acute DIC featured severe hypofibrinogenemia, thrombocytopenia, elevated fibrin D-dimer and multiple bilateral renal infarcts. Two of the three transfused units reacted with pre-existing RBC alloantibodies [anti-K (titre, 128), anti-Fya (titre, 512)], explained by transfusion 25 years earlier. Our literature review found the frequency of acute HTR following emergency transfusion of uncross-matched RBC units to be 2/3998 [0·06% (95% CI, 0·01-0·21%)].
CONCLUSIONS:

Although emergency transfusion of uncross-matched blood is commonly practiced at trauma centres worldwide, with low risk of acute HTR (

DOI10.1111/tme.12513
Alternate JournalTransfus Med
Notify Library Reference ID4682

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