Non-immune mediated haemolysis

When to suspect this adverse reaction?

The symptoms vary depending on the degree of haemolysis and the amount of component transfused. Most non-immune mediated haemolysis situations are benign, but life-threateneing haemolysis with severe anaemia and renal failure may occur.

Patients often present with fever and increased pulse rate. Transfused patients may develop haemoglobinuria and haemoglobinaemia.

The incidence rate for acute nonimmune-mediated haemolysis is rare.(1)
 

Usual causes?

Causes leading to non-immune mediated red cell haemolysis include:(1,2)

  • Inadvertent freezing of red cells (transporting directly on ice or storage in freezer)
  • Incomplete deglycerolisation of frozen red cells
  • Transfusion of red cells under pressure through a small bore needle
  • Using a rapid pressure infuser
  • Overheating of red cells due to improper storage
  • Medical device malfunctions (blood warmers or cell savers) or use of hot waterbaths and microwaves to warm blood
  • Infusion of red cells simultaneously through the same tubing with hypotonic solutions or pharmacological agents
  • Bacterial contamination of the red cell unit
  • Transfusion of outdated red cells
  • Patient’s underlying disease process
     

Investigations (1)

Rule out immune haemolysis by performing a direct antiglobulin test (DAT) and repeat patient ABO group.

Test the transfused unit for haemolysis. Perform root-cause analysis to identify and eliminate the cause.
 

What to do? (1,2)

Stop transfusion immediately and follow other steps for managing suspected transfusion reactions.

Seek urgent medical assistance. Maintain blood pressure and renal output. Induce diuresis with intravenous fluids and diuretics.

This may become a medical emergency so support blood pressure and maintain an open airway.

Do not administer additional blood packs until cleared by haematologist or Transfusion Service Provider.
 

References
  1. Fung MK, Grossman BJ, Hillyer CD, Westhoff CM (ed). Non-infectious complications of blood transfusion. Chapter 27, AABB Technical Manual, 18th edition. AABB, Bethesda, 2014.

  2. Callum JL, Pinkerton PH, Lima A, Lin Y, Karkouti K, Lieberman, L, et al. Chapter 5, Transfusion Reactions. Bloody Easy 4: Blood Transfusions, Blood Alternatives and Transfusion Reactions: A Guide to Transfusion Medicine, 4rd edition. Canada: Ontario Regional Blood Coordinating Network, 2016.