**10. Treatment of transfusion haemolytic reactions**

Treatment of early haemolytic transfusion reactions depends mainly on the patient's condition, which must be closely monitored. It is most important to observe the clinical symptoms of the recipient and stop the blood transfusion at the right moment. Particular attention should be paid to the patient's circulation. In the event of a marked decrease in blood pressure, make-up fluids should be transfused and pressure amines should be administered. However, it is important to avoid overloading the circulation with fluids, especially in patients with heart or kidney failure. Catheterisation of the pulmonary artery helps to monitor the situation.

In some cases, an exchange transfusion should be considered, bearing in mind that the haemolysis intensity depends mainly on the volume of incompatible blood transfused. For exchange transfusion, red blood cells without an antigen should be used against which the patient has developed alloantibodies. The decision to carry it out must be balanced and the course carefully monitored. It should be emphasised that in patients with an early reaction due to ABO incompatibility, exchange transfusion may reduce the risk of serious complications or death. For patients with ongoing haemorrhage choosing a blood for transfusion may be difficult. However, it should be remembered that these difficulties must not cause risk of haemorrhage. Often the way out of this situation is transfusion of O RhD negative red blood cells.


#### **Table 9.**

*Therapeutic options in haemolytic transfusion reactions [1].*

The prevention of renal failure is aided by an early prevention of hypotension. A fluid balance should be maintained, the use of dehydrating agents (mannitol and furosemide) is helpful, but their oliguria should be closely monitored. Low doses of dopamine (1–5 μg/kg/min) may be used to maintain renal circulation, but this may not be effective.

Treatment and prevention of DIC during haemolytic transfusion reaction is controversial. Heparin is recommended because it additionally acts as an inhibitor of the complement activity and limits haemolysis. However, there is a danger of bleeding. Another method of treating early haemolytic transfusion reaction is to use a high dose of 0.4/kg intravenous immunoglobulin per 24 h after blood transfusion.

Delayed haemolytic transfusion reactions are well tolerated by most patients. Additional fluid and diuretic therapy are usually not necessary. Depending on the severity of the anaemia, transfusion of blood components should be avoided until the antibodies responsible for the reaction have been identified and the appropriate selection of blood cells has been made. Attempts have been made to use high doses of intravenous immunoglobulins to prevent haemolytic reactions in patients who have been immunised for winter and for whom compatible red blood cells have not been selected [63]. The main procedure for subsequent transfusions is to select red cells that do not contain the antigen for which all antibodies have been detected. **Table 9** summarises the treatment options used in haemolytic transfusion reactions.

## **11. Prevention of haemolytic transfusion reactions**

Data on the incidence of haemolytic transfusion reactions vary from country to country and change over time. There are several causes. One of them was the use of improved techniques for detecting clinically relevant alloantibodies, which reduce the number of haemolytic transfusion reactions observed in blood recipients. In addition, the widespread introduction of automation and computerisation to

**107**

**Author details**

**12. Summary**

Jolanta Korsak\* and Anna Piotrowska Military Institute of Medicine, Poland

provided the original work is properly cited.

\*Address all correspondence to: jkorsak@wim.mil.pl

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

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

ogy laboratories and blood banks.

adverse post-transfusion reaction.

duction of procedures eliminating further errors.

pre-transfusion studies, which significantly limits the possibility of errors in serol-

of mistakes made in hospitals leading to transfusion of inappropriate blood to the patient. These include, among others, errors in collecting blood samples from patients and blood transfusions to a wrong patient. These errors are the most common cause of ABO incompatible transfusions, threatening the patient's life.

The above improvements, however, did not significantly affect the elimination

The introduction of haemovigilance transfusiological surveillance systems has enabled the analysis of all fatal and severe transfusion reactions. It allows to identify malfunctioning procedures leading to transfusion reactions. It enforces the intro-

Preventing haemolytic transfusion reactions by focusing on advances in serology and transfusion medicine has significantly reduced their incidence. Progress in understanding reaction pathophysiology has helped clinically assess patients and treat them effectively. It is possible that technological progress enabling modification of red blood cells and the use of red blood cell substitutes will significantly change transfusion practice in the future and eliminate the occurrence of haemolytic transfusion reactions. But until then, HTRs will remain the most important

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

pre-transfusion studies, which significantly limits the possibility of errors in serology laboratories and blood banks.

The above improvements, however, did not significantly affect the elimination of mistakes made in hospitals leading to transfusion of inappropriate blood to the patient. These include, among others, errors in collecting blood samples from patients and blood transfusions to a wrong patient. These errors are the most common cause of ABO incompatible transfusions, threatening the patient's life.

The introduction of haemovigilance transfusiological surveillance systems has enabled the analysis of all fatal and severe transfusion reactions. It allows to identify malfunctioning procedures leading to transfusion reactions. It enforces the introduction of procedures eliminating further errors.
