Acute haemolysis, DIC and renal failure after transfusion of uncross‐matched blood during trauma resuscitation: illustrative case and literature review

摘要

SUMMARY Aims/Objectives The aims of this study were to report a patient with acute haemolytic transfusion reaction (HTR) after transfusing uncross‐matched red blood cell (RBC) units and to identify the frequency of this complication. Background Uncross‐matched RBC units are commonly transfused in emergencies, but the frequency of acute HTR is unknown. Methods We describe a male stabbing victim who received three units of uncross‐matched RBC units complicated by acute intravascular HTR, disseminated intravascular coagulation (DIC) and renal failure. We identified 14 studies evaluating the frequency of acute HTR post‐emergency transfusion of uncross‐matched RBC units. Results Acute HTR was shown by haemoglobinuria, free‐plasma haemoglobin and methemalbumin, with anti‐K and anti‐Fy a eluted from recipient red cells; acute DIC featured severe hypofibrinogenemia, thrombocytopenia, elevated fibrin D‐dimer and multiple bilateral renal infarcts. Two of the three transfused units reacted with pre‐existing RBC alloantibodies [anti‐K (titre, 128), anti‐Fy a (titre, 512)], explained by transfusion 25?years earlier. Our literature review found the frequency of acute HTR following emergency transfusion of uncross‐matched RBC units to be 2/3998 [0·06% (95% CI, 0·01–0·21%)]. Conclusions Although emergency transfusion of uncross‐matched blood is commonly practiced at trauma centres worldwide, with low risk of acute HTR (1/1000), our well‐documented patient case demonstrates the potential for acute HTR with severe complications.