Treatment of Acute Hemolytic Transfusion Reaction due to ABO-Incompatible Red Blood Cell Transfusion: A Case Report, Review of the Literature and Recommendation.

Although acute hemolytic transfusion reaction (AHTR) due to ABO-incompatible red blood cell transfusion is a rare complication in high-income countries, it is considered a medical emergency because of the severe intravascular hemolysis that can lead to major morbidity or death. AHTR can cause intravascular hemolysis, acute renal failure, disseminated intravascular coagulation (DIC), and shock, and therefore treatment should be prompted early and directed to prevent these complications. We present a case of AHTR due to ABO-incompatible red blood cell transfusion successfully treated with high-dose glucocorticoids, red blood cell, and therapeutic plasma exchange within 24 h. To our knowledge, there is no standard protocol for treatment of ABO-incompatible red blood cell transfusions. We performed a review of the literature and made a recommendation for the treatment of AHTR due to ABO-incompatible transfusion. Based on the existing literature and the presented case we advise, beside supportive measures and hemodialysis in case of renal failure, to consider more invasive therapies, such as therapeutic plasma exchange, red blood cell exchange or complement inhibiting drugs to prevent acute and long-term complications. Daily measures of relevant laboratory parameters should be performed, and if hemolysis is apparent, repeated procedures should be considered.