**12. Summary**

*Human Blood Group Systems and Haemoglobinopathies*

Hydration Prevent renal impairment

Alkalinisation of urine Prevent renal impairment

Red cells exchange transfusion Decrease load of

Intravenous immunoglobulin (not

standard therapy)

**Table 9.**

Plasma or platelet transfusion Treat haemorrhagic

*DIC—disseminated intravascular coagulation; FFP—fresh frozen plasma.*

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

**Therapeutic intervention Indication Typical dose**

>100 ml/h

Maintain urine output

Maintain urine pH > 7.5

Diuresis Prevent renal impairment Mannitol 20% 100 ml/m2

Vasodilation Increase renal blood flow Dopamine 1–5 μg/kg/min Anticoagulant Treat DIC Heparin 5–10 u/kg/h

incompatible red cells

complications of DIC

Prevent extravascular

haemolysis

Normal saline and/or 5% dextrose

/h

NaH2CO3 40–70 mEq

Furosemide 40–80 mg

unit apheresis platelet FFP—10 ml/kg

Exchange of one estimated red

Platelet—1 unit platelet/10 kg or 1

200 ml/m2

cells mass

0.4 mg/kg

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

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

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

**11. Prevention of haemolytic transfusion reactions**

**106**

reactions.

not be effective.

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 adverse post-transfusion reaction.
