According to AABB, a professional organization of blood banks, approximately 40,000 units of blood are used daily in the United States. People undergoing surgery, accident victims, cancer patients and others with decreased blood volume often need blood transfusions. Reactions to blood transfusion may occur. An acute hemolytic transfusion reaction is the most severe form. It typically occurs when the transfused blood is incompatible with the recipient's blood type. The immune system reacts almost immediately, attacking and rupturing the transfused blood cells. Sudden symptoms develop, alerting the health care team that an acute hemolytic reaction may be underway.
Flushing
An acute hemolytic transfusion reaction may cause almost immediate flushing wherein the skin turns bright pink. This is most easily observed in the face, although flushing may be widely distributed.
Pain at the Infusion Site
Transfusion of incompatible blood typically causes burning or aching pain at the IV site where the blood is entering the body. Pain may extend along the blood vessel into which the transfused blood is flowing. The skin over the infusion site and along the blood vessel path may be warm to the touch.
Anxiety
People experiencing an acute hemolytic transfusion reaction often report sudden, extreme anxiety as the transfused blood enters the body. Feelings of danger or looming disaster are commonly experienced.
Low Back, Flank and Chest Pain
A transfusion with incompatible blood frequently causes low back or flank pain. The flank is the region between the hipbone and the ribs. Chest pain and tightness are also common symptoms of this serious transfusion reaction. In a review article entitled, "Errors in Transfusion Medicine: Scope of the Problem" published in "Archives of Pathology and Laboratory Medicine," Dr. J. Linden reported the risk of a fatal hemolytic transfusion reaction is approximately one in 600,000 to one in 800,000.
Fever and Chills
The immune system response in an acute hemolytic transfusion reaction causes a rapid spike in body temperature. Shaking chills commonly accompany the fever.
Cold, Clammy Skin
An acute hemolytic transfusion reaction commonly causes shock. With shock, the blood pressure drops precipitously causing cold, clammy skin. These skin effects are due to a release of epinephrine, the "fight or flight" hormone.
Shortness of Breath and Pounding Heartbeat
The symptoms of an acute hemolytic transfusion reaction typically begin within the first five to 60 minutes of beginning the transfusion. Shortness of breath and a pounding, rapid heartbeat develop as the body goes into shock. "The Merck Manual for Healthcare Professionals" reports approximately 20 people die yearly in the United States of acute hemolytic transfusion reaction.
References
- University of Michigan Department of Pathology: Blood Bank and Transfusion Services, 7 Adverse Reactions to Transfusion
- University of Maryland Medical Center: Hemolytic Transfusion Reaction Symptoms
- Merck Manual: Acute Hemolytic Transfusion Reaction
- National Heart, Lung and Blood Institute: What Are the Risks of a Blood Transfusion?
- ClinLab Navigator: Acute Hemolytic Transfusion Reaction
