Treatment measures for hemolytic reaction

There are always accidents in life. When people suffer from unexpected heavy blood loss or when patients with coagulation disorders accidentally bleed, they need blood transfusion. my country's blood management has been greatly improved, blood testing for blood donors is also being gradually improved, and the risk of blood transfusion has been greatly reduced compared with before. However, there is one situation in blood transfusion that is difficult to control, and that is the hemolytic reaction.

Hemolysis is a reaction in which the red blood cell membrane is damaged, causing hemoglobin to flow out of the red blood cells. This phenomenon is common in blood transfusion reactions and poisoning. People who experience this reaction will experience symptoms such as headache, chest pain, and precordial pressure. In severe cases, it can lead to death. Hemolysis generally refers to the destruction of the red blood cell membrane, or the appearance of multiple small holes, or the reaction of hemoglobin flowing out of the red blood cells due to extreme stretching. The red blood cell free fluid becomes dark red as the transparency increases with hemolysis. Hemolysis can be divided into two categories: (1) Hemolysis that occurs specifically as a type of antigen-antibody reaction (called immune hemolysis). (2) Non-specific occurrences due to physical, chemical, or biological factors. The former antibody binds to red blood cells, and hemolysis occurs when complement binds to the complex. Nonspecific hemolysis is caused by physical factors such as mechanical action (strong vibration, etc.), heating or freezing, and decrease in free fluid osmotic pressure, or by chemical factors such as acid, alkali, bile acid, and saponin. In addition, biological toxins such as snake venom, ricin and other plant toxins, and streptolysin. Bacterial toxins such as chloramphenicol can cause hemolysis. If hemolysis is severe, anemia and jaundice will occur. The disease that presents this symptom is called hemolytic anemia (also known as hemolytic jaundice) reaction.

Hemolytic reaction during blood transfusion. This is the most serious complication of blood transfusion and can cause shock, acute renal failure and even death. The common cause is the mistaken transfusion of incompatible red blood cells of the AB0 blood type. A few cases may be due to improper handling of the blood before transfusion, such as blood being stored for too long, the temperature being too high or too low, severe vibration of the blood, or the mistaken addition of hypotonic fluids causing a large number of red blood cells to be destroyed. The typical clinical manifestation is that after transfusing 10 to 20 ml of the abnormal blood, the patient will feel headache, chest pain, precordial pressure, general discomfort, back pain, chills, high fever, nausea, vomiting, pale complexion, irritability, rapid breathing, rapid pulse, and even shock; followed by hemoglobinuria and abnormal bleeding. If the shock is not corrected promptly and effectively, symptoms of acute renal failure such as oliguria and anuria will appear. Since surgical patients under anesthesia have no complaints, their earliest signs are unexplained drop in blood pressure, bleeding in the surgical field, and hemoglobinuria. In the early stages of the disease, mild symptoms are sometimes difficult to distinguish from fever reactions. In typical cases, the diagnosis can be made immediately based on the above-mentioned manifestations that occur rapidly after blood transfusion. When a hemolytic reaction is suspected, blood transfusion should be stopped immediately, the name and blood type of the recipient and donor should be checked, and venous blood should be drawn to observe the color of the plasma. The plasma of hemolyzed individuals is pink. At the same time, a centrifugal smear examination is performed to show that the serum contains hemoglobin during hemolysis. Observe the patient's urine volume and urine color every hour. When hemolysis occurs, the urine will be brown or dark brown. Urine hemoglobin measurement can reveal hemoglobin in the urine. Collect blood samples from the blood bag of the blood donor and the blood samples from the blood recipient before and after transfusion, re-identify blood types, perform cross-matching tests, and perform bacterial smears and cultures to identify the cause of hemolysis.

treat

Treatment focuses on:

If a hemolytic reaction is suspected, the blood transfusion should be stopped immediately, and the venous blood should be drawn and centrifuged to observe the color of the plasma. If it is pink, it proves that hemolysis has occurred. The following treatments should be performed:

① Anti-shock: intravenous infusion of plasma, low molecular weight dextran or fresh whole blood of the same type to correct shock and improve renal blood perfusion;

② Protect renal function: When blood pressure is stable, intravenously infuse 20% mannitol (0.5-1g/kg) or furosemide (Lasix) 40-60mg, and repeat once every 4 hours if necessary until hemoglobinuria basically disappears; intravenously drip 250ml of 5% sodium bicarbonate to alkalize urine, promote the dissolution of hemoglobin crystals, and prevent renal tubular obstruction;

③Maintain water, electrolyte, acid and alkali balance;

④Prevent and treat DIC;

⑤ If the amount of transfused heterotypic blood is too large or the symptoms are severe, exchange transfusion therapy may be considered;

⑥ If oliguria or anuria occurs, treat as acute renal failure.