![]() ![]() Because delayed hemolytic transfusion reaction is usually mild and self-limited, it is often unidentified, and the clinical clue may be an unexplained drop in hemoglobin to the pretransfusion level occurring 1 to 2 weeks posttransfusion. Usually, only destruction of the transfused RBCs (with the antigen) occurs, resulting in a falling hematocrit and a slight rise in lactate dehydrogenase and bilirubin and a positive direct antiglobulin test. Rarely, severe symptoms (eg, low-grade fever, jaundice) occur. Patients may be asymptomatic or have a slight fever. A delayed hemolytic transfusion reaction usually does not manifest as dramatically as acute hemolytic transfusion reaction. After transfusion with RBCs bearing this antigen, a primary or anamnestic response may result (usually in 1 to 4 weeks) and cause a delayed hemolytic transfusion reaction. Occasionally, a patient who has been sensitized to an RBC antigen has very low antibody levels and negative pretransfusion tests. After transfusion of RBCs, 2,3-DPG regenerates within 12 to 24 hours. Left ventricular (LV) failure causes shortness of breath and fatigue, and right ventricular (RV) failure causes peripheral and abdominal. read more who present with acute chest syndrome or stroke, and in some patients with severe heart failure Heart Failure (HF) Heart failure (HF) is a syndrome of ventricular dysfunction. It is caused by homozygous inheritance of genes for hemoglobin. There is little evidence that 2,3-DPG deficiency is clinically significant except in exchange transfusions in infants, in patients with sickle cell disease Sickle Cell Disease Sickle cell disease (a hemoglobinopathy) causes a chronic hemolytic anemia occurring almost exclusively in people with African ancestry. This absence results in an increased affinity for oxygen and slower release of oxygen to the tissues. read more (eg, dyspnea, crackles) occur, the transfusion should be stopped and treatment for heart failure begun.īlood stored for > 7 days has decreased RBC 2,3-diphosphoglycerate (DPG), and the 2,3-DPG is absent after >10 days. The patient should be observed and, if signs of heart failure Heart Failure (HF) Heart failure (HF) is a syndrome of ventricular dysfunction. The high osmotic load of blood products draws volume into the intravascular space over the course of hours, which can cause transfusion-associated circulatory overload in susceptible patients (eg, those with cardiac or renal insufficiency). Although transfusion-associated circulatory overload is underrecognized and underreported, it has been recognized as the most common cause of transfusion-related deaths reported to the FDA ( 1 General references The most common complications of transfusion are Febrile nonhemolytic reactions Chill-rigor reactions The most serious complications, which have very high mortality rates, are Acute hemolytic. ![]()
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