Acute renal failure from hemolytic transfusion reactions Dr Mojgan Mortazavi Associate professor of nephrology Isfahan kidney Diseases research center

Acute hemolytic transfusion reaction ABO incompatability is the major cause of death from transfusion IgM anti-A and anti-B fix complement  rapid intravascular hemolysis Acute renal failure from ATN DIC Shock Hyperkalemia Renal failure can be caused by direct toxicity of hemoglobin and by renal ischemia from shock

Acute transfusion reactions Acute haemolytic transfusion reaction due to ABO incompatible blood or bacterial contamination difficult to differentiate clinically causes: acute intravascular haemolysis shock acute renal failure DIC extremely serious, can be fatal

Hemoglobinuria Alpha-Beta dimers MW 34,000 -- small enough to be filtered by glomerulus

Proposed mechanisms of renal injury 1. Obstruction of tubules with heme pigment casts 2. Oxidative damage to proximal tubule by released free iro

Approach to the patient with red or brown urine                                                                              Electrolyte abnormalities 

AHTR: Symptoms & Signs Patient feels unwell and agitated Symptoms Fever, rigors Headache, SOB Loin/back pain Pain at infusion site Signs Hypotension Reduced urine output  acute renal failure Bleeding from venepuncture sites due to DIC Urinalysis: haemoglobinuria

Management of AHTR A medical emergency: Stop transfusion immediately Keep line open with N/Saline using new giving set Monitor pulse, BP, temp Call member of medical staff Check identity of patient against blood bag Take urgent blood samples: FBC, cross-match, U & Es, clotting screen, blood cultures Save any urine Send blood unit back to the blood bank

Prevention of ARF Volume repletion Alkalinization of urine

MANAGEMENT Plasma volume expansion with intravenous isotonic saline should be given as soon as possible, even while trying to establish the cause of the hemolysis.

Monitoring with serial measurements of serum potassium, calcium, phosphate, and creatinine ,LDH is recommended.

Late Treatment Dialysis – intermitted preferred to continuous Reduce use of anticoagulants in trauma patients