Hemolytic Transfusion Reactions (HTR) are serious complications resulting from the lysis of red blood cells (RBCs), leading to the release of free hemoglobin. This can cause hypotension, oliguria, hemoglobinuria, and potentially severe renal failure.
Prompt and aggressive management is essential.
1. Immediate and Diagnostic Steps
| Step | Action and Rationale |
| Stop Transfusion | The first and most immediate step upon suspicion of HTR. Discontinue the blood product infusion immediately. |
| Confirm Diagnosis | Send the remaining blood product and a new blood sample from the patient back to the blood bank for re-checking the blood group. Clerical error is the most common cause of HTR. |
| Initial Investigations | Order immediate investigations, including a Full Blood Count, Coagulation Studies, and Serum Bilirubin. |
| Monitor Urine Output | Insert a Foley catheter. This is essential to:1. Demonstrate and quantify oliguria. 2. Guide fluid resuscitation efforts. 3. Diagnose hemoglobinuria (red or dark urine), a gross diagnostic feature of HTR. |
2. Supportive and Renal Protective Therapy
The primary goals are to counter hypotension and prevent acute kidney injury by clearing free hemoglobin.
- Aggressive Fluid Resuscitation: Initiate immediately to counter hypotension and significantly increase the urine output, helping to flush free hemoglobin from the kidneys.
- Maintain High Urine Output: The goal should be to maintain urine output at $>100 \text{ mL/hour}$.
- Osmotic Diuretics: Consider adding osmotic diuretics (e.g., mannitol) as an adjunct to aggressive fluid resuscitation to promote diuresis.
- Urine Alkalization (pH > 7): Administer sodium bicarbonate to alkalize the urine (maintain $\text{pH} > 7$). This helps to prevent free hemoglobin from clumping within the renal tubules, which minimizes tubular damage.
3. Note on Pharmacotherapy
- Steroids: Steroids have no proven role in the acute management of Hemolytic Transfusion Reactions.