0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40
Immune Hemolytic Anemia 815IMMEDIATELY; aggressive treatment for or to prevent renal failure
with iv fluids and diuretics (furosemide); pressor support if needed
(low-dose dopamine has also been thought to promote renal blood
flow) (but there is progressivelylessconvincing evidence from crit-
ical care medicine clinical trials that this is indeed the case!); treat
DIC with platelets and plasma or cyroprecipitate as needed for life-
threatening bleeding; heparin for thrombosis
■delayed hemolytic transfusion reaction (see chapter on Transfusion
Reactions): alloantibodies to non-ABO red blood cell antigens (e.g.,
Rhesus, Kidd, Kell, Duffy, MNSs) react with transfused incompati-
ble red blood cells, often resulting in extravascular hemolysis, fever,
jaundice and inadequate hemoglobin responses to transfusion; DAT
positive for IgG; IAT positive for IgG alloantibody; supportive care
and transfusion with antigen-negative red blood cells
■post-transplant hemolysis: extravascular hemolysis infrequently
seen following hematopoietic or solid organ transplants; donor lym-
phocytes contained within graft produce alloantibodies against ABO
or other red blood cell antigens absent in the donor but present in
the recipient; fever, jaundice, progressive anemia; DAT positive for
IgG; IAT positive for IgG alloantibody; self-limiting; supportive care
and transfusion with antigen-negative red blood cells
■hemolytic disease of the newborn: IgG alloantibodies to non-ABO
red cell antigens and naturally occurring anti-A,B IgG antibodies
in the mother cross the placenta and bind to corresponding anti-
gens present on the fetal red blood cells; extravascular hemolysis;
severity ranges greatly from asymptomatic with a positive DAT to
severe anemia and jaundice resulting in kernicterus, mental retar-
dation, hydrops fetalis, stillbirth, or death shortly after birth. Preven-
tion and treatment include prenatal screening (maternal ABO/Rh
typing, antibody screen, antibody titers; paternal red cell antigen
typing), RhoGAM administration, ultrasonography, amniocentesis,
PUBS and intrauterine transfusion, Kleihauer-Betke test, photother-
apy, exchange transfusion, newborn screening (ABO/Rh typing, DAT,
hemoglobin levels and bilirubin levels)management
What to Do First/General Measures
■WAHA
■transfuse symptomatic patients with ABO/Rh compatible cross-
match least incompatible red blood cells
■patients with accompanying clinically significant alloantibody or
warm-reactive autoantibody with a definite specificity should