**8. Differentiation**

Early haemolytic transfusion reactions should be differentiated with septic shock due to bacterial contamination of the blood component, as well as anaphylaxis and bleeding. In addition, immune haemolysis of nocturnal paroxysmal haemoglobinuria or autoimmune anaemia should also be considered. The cause of an early haemolytic reaction may also be congenital haemolytic anaemia, for example, glucose-6-phosphate dehydrogenase deficiency or microangiopathic haemolytic

	- use of inappropriate fluids
	- improper storage of blood components
	- defects in the blood-heating devices
	- needle diameter too small, haematocrit of transfused red blood cells too high
	- an inappropriate method of freezing/thawing red blood cells
	- using the wrong infusion pumps
	- bacterial infection of blood components
	- mechanical damage to blood cells, artificial valves
	- thrombocytopenic thrombosis (TTP)
	- haemolytic uremic syndrome
	- HELLP syndrome
	- *Clostridium perfringens*
	- Malaria
	- Babesiosis

#### **Table 6.**

*Differential diagnosis of haemolytic transfusion reactions [1].*

**103**

*Post-Transfusion Haemolytic Reactions DOI: http://dx.doi.org/10.5772/intechopen.91019*

haemolytic transfusion reactions.

haemolytic reactions is shown in **Table 7**.

blood cells through a small needle diameter, etc.

of red blood cells, for example, artificial heart valves and TTP.

(DTA) is positive and elevated bilirubin and LDH are found.

**9. Diagnosis of transfusion haemolytic reactions**

remaining after the transfusion cessation should be conducted.

anaemia (TTP, HUS and HELLP). In differential diagnosis, attention should also be paid to non-immune reasons related to improper blood storage, transfusion of red

Differential diagnosis of delayed haemolytic transfusion reactions includes latent sources of infection, autoimmune haemolytic anaemia, cold agglutinin disease, nocturnal paroxysmal haemoglobinuria, bleeding, mechanical destruction

It should be noted that an increase in body temperature and white blood cell count, typical for DHTR, can be interpreted as a sign of infection. In some patient groups, it may be difficult to recognise a delayed haemolytic transfusion reaction. Patients with liver failure are a special problem. Haemoglobinemia is not diagnosed in the serum of these patients due to jaundice, often direct antiglobulin reaction

Another group are patients with absorbing haematomas. They may be similar to delayed haemolytic reactions. Elevated unbound bilirubin, LDH and decreased haptoglobin are observed. The presence of fibrinogen degradation products from an absorbing haematoma can be interpreted as a DIC symptom. DHTR can be identified in these patients by the presence of antigen on the transfused red blood cells to which the antibodies may be directed. **Table 6** presents the differential diagnosis of

If a haemolytic transfusion reaction is suspected, medical personnel should immediately stop transfusing a blood component. The blood unit should be checked at the patient's bedside, whether it was properly administered. Often, the clinical manifestations of haemolytic reactions are not clear, and the cause of the complication should be differentiated with bacterial infection. Therefore, prior to conducting laboratory tests of donor blood, bacteriological examination of the component

**9.1 Tests carried out in case of suspected early hemolytic transfusion reaction**

Laboratory tests—mainly serological—are crucial for the diagnosis of an early haemolytic reaction. The type of laboratory tests performed for early transfusion

The basic serological examination consists of direct antiglobulin testing (DAT); determination of blood group and RhD in donor and recipient; repetition of the serological compliance test. A test should be performed for the presence of antibodies in the recipient before and after the transfusion. Positive DAT indicates haemolysis of red blood cells of immunisation origin. A negative DAT result does not exclude haemolysis, it may mean that the transfused blood cells have been destroyed by alloantibodies or the method used is not very sensitive. Alvarez et al. [60] compared the sensitivity of DAT performed by technique using monospecific IgG antiglobulin, flow cytometry and antibody elution. The study showed that DAT could only indicate 10% of antibody coated cells [61]. Performing DAT in the red blood cell eluate, its sensitivity was 1%. Flow cytometry proved to be a similarly sensitive method. The re-determination of the ABO and RhD blood group of the recipient before and after the transfusion and in the donors' blood will exclude errors in the identification of the recipient or blood sample (wrong blood in tube (WBIT)). Test results carried out by Biomedical Excellence for Safer Transfusion Working Party of The International Society for Blood Transfusion in 10 countries with 62 institutions,

#### *Post-Transfusion Haemolytic Reactions DOI: http://dx.doi.org/10.5772/intechopen.91019*

*Human Blood Group Systems and Haemoglobinopathies*

the patient were destroyed.

• Alloantibodies responsible for haemolysis • Delayed serological transfusion reaction • Autoimmune haemolytic anaemia

○ improper storage of blood components ○ defects in the blood-heating devices

○ using the wrong infusion pumps ○ bacterial infection of blood components

• Drug-induced haemolysis of red blood cells • Microangiopathic haemolytic anaemia ○ thrombocytopenic thrombosis (TTP) ○ haemolytic uremic syndrome

• Nocturnal paroxysmal haemoglobinuria

*Differential diagnosis of haemolytic transfusion reactions [1].*

• Congenital haemolytic anaemia

• Haemoglobinopathies

○ HELLP syndrome

○ *Clostridium perfringens*

• Bleeding

• Polyagglutination • Infections

> ○ Malaria ○ Babesiosis

○ needle diameter too small, haematocrit of transfused red blood cells too high

○ an inappropriate method of freezing/thawing red blood cells

○ mechanical damage to blood cells, artificial valves

• Cold agglutinins disease • Non-immune haemolysis ○ use of inappropriate fluids

**8. Differentiation**

when red blood cells became the "bystander" of leukocyte reactions and antibodies directed to them, they underwent haemolysis. The reaction of anti-HLA antibodies with leucocytes caused complement activation, which resulted in haemolysis of the patient's red blood cells sensitive to the complement [59]. It is noteworthy that in patients with a haemolytic reaction associated with the immune cytolysis of the "bystander" not only transfused red blood cells but also autologous blood cells of

Early haemolytic transfusion reactions should be differentiated with septic shock due to bacterial contamination of the blood component, as well as anaphylaxis and bleeding. In addition, immune haemolysis of nocturnal paroxysmal haemoglobinuria or autoimmune anaemia should also be considered. The cause of an early haemolytic reaction may also be congenital haemolytic anaemia, for example, glucose-6-phosphate dehydrogenase deficiency or microangiopathic haemolytic

**102**

**Table 6.**

anaemia (TTP, HUS and HELLP). In differential diagnosis, attention should also be paid to non-immune reasons related to improper blood storage, transfusion of red blood cells through a small needle diameter, etc.

Differential diagnosis of delayed haemolytic transfusion reactions includes latent sources of infection, autoimmune haemolytic anaemia, cold agglutinin disease, nocturnal paroxysmal haemoglobinuria, bleeding, mechanical destruction of red blood cells, for example, artificial heart valves and TTP.

It should be noted that an increase in body temperature and white blood cell count, typical for DHTR, can be interpreted as a sign of infection. In some patient groups, it may be difficult to recognise a delayed haemolytic transfusion reaction. Patients with liver failure are a special problem. Haemoglobinemia is not diagnosed in the serum of these patients due to jaundice, often direct antiglobulin reaction (DTA) is positive and elevated bilirubin and LDH are found.

Another group are patients with absorbing haematomas. They may be similar to delayed haemolytic reactions. Elevated unbound bilirubin, LDH and decreased haptoglobin are observed. The presence of fibrinogen degradation products from an absorbing haematoma can be interpreted as a DIC symptom. DHTR can be identified in these patients by the presence of antigen on the transfused red blood cells to which the antibodies may be directed. **Table 6** presents the differential diagnosis of haemolytic transfusion reactions.
