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<TITLE>Acute hemolytic transfusion reaction - Wikipedia</TITLE>

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<H1 id="firstHeading" class="firstHeading" lang="en">Acute hemolytic transfusion reaction</H1>			<DIV id="bodyContent" class="mw-body-content">
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<P>An <B>acute hemolytic transfusion reaction</B> (AHTR) is a type of <A href="/wiki/Transfusion_reaction" class="mw-redirect" title="Transfusion reaction">transfusion reaction</A> that is associated with <A href="/wiki/Hemolysis" title="Hemolysis">hemolysis</A>. It occurs very soon after the transfusion, and within 24 hrs post-transfusion.<SUP id="cite_ref-pmid15373591_1-0" class="reference"><A href="#cite_note-pmid15373591-1">[1]</A></SUP> It can occur quickly upon transfusing a few milliliters, or up to 1–2 hours post-transfusion.<SUP id="cite_ref-2" class="reference"><A href="#cite_note-2">[2]</A></SUP></P>
<P>It is also known as an "immediate hemolytic transfusion reaction".<SUP id="cite_ref-pmid_3-0" class="reference"><A href="#cite_note-pmid-3">[3]</A></SUP> This is a medical emergency as it results from rapid destruction of the donor red blood cells by host antibodies (IgG, IgM). It is usually related to ABO blood group incompatibility - the most severe of which often involves group A red cells being given to a patient with group O type blood. <A href="/wiki/Properdin" title="Properdin">Properdin</A> then binds to complement C3 in the donor blood, facilitating the reaction through the alternate pathway cascade. The donor cells also become coated with IgG and are subsequently removed by macrophages in the <A href="/wiki/Reticuloendothelial_system" class="mw-redirect" title="Reticuloendothelial system">reticuloendothelial system</A> (RES). <A href="/wiki/Jaundice" title="Jaundice">Jaundice</A> and <A href="/wiki/Disseminated_intravascular_coagulation" title="Disseminated intravascular coagulation">disseminated intravascular coagulation</A> (DIC) may also occur. The most common cause is clerical error (i.e. the wrong unit of blood being given to the patient).</P>
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<H2>Contents</H2>
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<LI class="toclevel-1 tocsection-1"><A href="#Epidemiology"><SPAN class="tocnumber">1</SPAN> <SPAN class="toctext">Epidemiology</SPAN></A></LI>
<LI class="toclevel-1 tocsection-2"><A href="#Types"><SPAN class="tocnumber">2</SPAN> <SPAN class="toctext">Types</SPAN></A>
<UL>
<LI class="toclevel-2 tocsection-3"><A href="#Intravascular_haemolysis"><SPAN class="tocnumber">2.1</SPAN> <SPAN class="toctext">Intravascular haemolysis</SPAN></A></LI>
<LI class="toclevel-2 tocsection-4"><A href="#Extravascular_haemolysis"><SPAN class="tocnumber">2.2</SPAN> <SPAN class="toctext">Extravascular haemolysis</SPAN></A></LI>
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<LI class="toclevel-1 tocsection-5"><A href="#Signs_and_symptoms"><SPAN class="tocnumber">3</SPAN> <SPAN class="toctext">Signs and symptoms</SPAN></A></LI>
<LI class="toclevel-1 tocsection-6"><A href="#Pathophysiology"><SPAN class="tocnumber">4</SPAN> <SPAN class="toctext">Pathophysiology</SPAN></A>
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<LI class="toclevel-2 tocsection-7"><A href="#Immune_mediated"><SPAN class="tocnumber">4.1</SPAN> <SPAN class="toctext">Immune mediated</SPAN></A></LI>
<LI class="toclevel-2 tocsection-8"><A href="#Non-immune_mediated"><SPAN class="tocnumber">4.2</SPAN> <SPAN class="toctext">Non-immune mediated</SPAN></A></LI>
</UL>
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<LI class="toclevel-1 tocsection-9"><A href="#Diagnosis"><SPAN class="tocnumber">5</SPAN> <SPAN class="toctext">Diagnosis</SPAN></A>
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<LI class="toclevel-2 tocsection-10"><A href="#Differential_diagnoses"><SPAN class="tocnumber">5.1</SPAN> <SPAN class="toctext">Differential diagnoses</SPAN></A></LI>
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<LI class="toclevel-1 tocsection-11"><A href="#Management"><SPAN class="tocnumber">6</SPAN> <SPAN class="toctext">Management</SPAN></A></LI>
<LI class="toclevel-1 tocsection-12"><A href="#Prognosis"><SPAN class="tocnumber">7</SPAN> <SPAN class="toctext">Prognosis</SPAN></A></LI>
<LI class="toclevel-1 tocsection-13"><A href="#Epidemiology_2"><SPAN class="tocnumber">8</SPAN> <SPAN class="toctext">Epidemiology</SPAN></A></LI>
<LI class="toclevel-1 tocsection-14"><A href="#References"><SPAN class="tocnumber">9</SPAN> <SPAN class="toctext">References</SPAN></A></LI>
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<H2><SPAN class="mw-headline" id="Epidemiology">Epidemiology</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=1" title="Edit section: Epidemiology">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<P>In the USA in 2011 there were 48 episodes of acute hemolysis due to a mismatch in ABO blood type (1 in 495,207 blood components transfused) and 168 episodes of hemolysis due to other causes (1 in 124,525 blood components transfused).<SUP id="cite_ref-:2_4-0" class="reference"><A href="#cite_note-:2-4">[4]</A></SUP> In the UK in 2014 there were 18 episodes of hemolysis due to other causes (1 in 147,972 blood components transfused).<SUP id="cite_ref-:1_5-0" class="reference"><A href="#cite_note-:1-5">[5]</A></SUP></P>
<H2><SPAN class="mw-headline" id="Types">Types</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=2" title="Edit section: Types">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<P>Acute hemolytic transfusion reactions are divided into two types.</P>
<H3><SPAN class="mw-headline" id="Intravascular_haemolysis">Intravascular haemolysis</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=3" title="Edit section: Intravascular haemolysis">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H3>
<P>The most common cause of this reaction is ABO blood groups incompatibility, secondary to human errors. In this process, the donor's red blood cells are destroyed by recipient's preformed antibodies through the activation of <A href="/wiki/Complement_system" title="Complement system">complement system</A>. Thus, the donor's red blood cells break open and releases <A href="/wiki/Haemoglobin" class="mw-redirect" title="Haemoglobin">haemoglobin</A> into the blood. The haemoglobin is then excreted into urine, causes <A href="/wiki/Haemoglobinuria" class="mw-redirect" title="Haemoglobinuria">haemoglobinuria</A>. Meanwhile, haemoglobin can also pass through the liver system and process into <A href="/wiki/Bilirubin" title="Bilirubin">bilirubin</A>, which accumulates under the skin, causing <A href="/wiki/Jaundice" title="Jaundice">jaundice</A>. The release of red blood cell debris and the activation of complement system causes uncontrolled clotting (<A href="/wiki/Disseminated_intravascular_coagulation" title="Disseminated intravascular coagulation">disseminated intravascular coagulation</A>) and <A href="/wiki/Shock_(circulatory)" title="Shock (circulatory)">circulatory shock</A>.<SUP id="cite_ref-LauraDean_6-0" class="reference"><A href="#cite_note-LauraDean-6">[6]</A></SUP></P>
<H3><SPAN class="mw-headline" id="Extravascular_haemolysis">Extravascular haemolysis</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=4" title="Edit section: Extravascular haemolysis">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H3>
<P>In this case, the donor's red blood cells are recognised and bound to <A href="/wiki/IgG_antibodies" class="mw-redirect" title="IgG antibodies">IgG antibodies</A>. Macrophages then recognise these IgG antibodies and engulf these red blood cells, removing the red blood cells from the blood circulation into liver and spleen. These red blood cells are then destroyed by macrophages in these organs. Anti-Rh antibodies most commonly directed this type of reaction. This process is much more controlled when compared with intravascular haemolysis. Liver has adequate capacity in processing the bilirubin. Therefore, jaundice rarely occurs.<SUP id="cite_ref-LauraDean_6-1" class="reference"><A href="#cite_note-LauraDean-6">[6]</A></SUP></P>
<H2><SPAN class="mw-headline" id="Signs_and_symptoms">Signs and symptoms</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=5" title="Edit section: Signs and symptoms">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<P>Early signs are <A href="/wiki/Fever" title="Fever">fever</A>, <A href="/wiki/Hypotension" title="Hypotension">low blood pressure</A>, anxiety, and red-colored urine.</P>
<P>Late signs are generalized bleeding, caused by <A href="/wiki/Disseminated_intravascular_coagulation" title="Disseminated intravascular coagulation">disseminated intravascular coagulation</A>, and low blood pressure.</P>
<P>Laboratory assessment is based on a positive Direct Antiglobulin Test (DAT), a decrease in serum <A href="/wiki/Haptoglobin" title="Haptoglobin">haptoglobin</A>, and an increase in blood levels of the enzyme <A href="/wiki/Lactate_dehydrogenase" title="Lactate dehydrogenase">lactate dehydrogenase</A> and indirect <A href="/wiki/Bilirubin" title="Bilirubin">bilirubin</A> levels.<SUP id="cite_ref-7" class="reference"><A href="#cite_note-7">[7]</A></SUP></P>
<H2><SPAN class="mw-headline" id="Pathophysiology">Pathophysiology</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=6" title="Edit section: Pathophysiology">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<H3><SPAN class="mw-headline" id="Immune_mediated">Immune mediated</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=7" title="Edit section: Immune mediated">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H3>
<P>This may be caused by preformed <A href="/wiki/IgM" class="mw-redirect" title="IgM">IgM</A> anti-A, anti-B or both. It may also be caused by other non-ABO <A href="/wiki/IgG" class="mw-redirect" title="IgG">IgG</A> antibodies such as Rh, Kell, or Duffy. The former results in a severe <A href="/wiki/Intravascular_hemolysis" class="mw-redirect" title="Intravascular hemolysis">intravascular hemolysis</A> and the latter typically causes <A href="/wiki/Extravascular_hemolysis" class="mw-redirect" title="Extravascular hemolysis">extravascular hemolysis</A>. The reactions are mediated by cytokines like <A href="/wiki/TNF" class="mw-redirect" title="TNF">TNF</A>, <A href="/wiki/Interleukin_8" title="Interleukin 8">IL-8</A>, <A href="/w/index.php?title=Monocyte_chemoattractant_protein&action=edit&redlink=1" class="new" title="Monocyte chemoattractant protein (page does not exist)">monocyte chemoattractant protein</A>, <A href="/wiki/Interleukin_1" class="mw-redirect" title="Interleukin 1">IL-1</A> etc.</P>
<H3><SPAN class="mw-headline" id="Non-immune_mediated">Non-immune mediated</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=8" title="Edit section: Non-immune mediated">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H3>
<P>These occur when RBCs are damaged before transfusion, resulting in hemoglobinemia and hemoglobinuria. Clinical symptoms are nil or milder.</P>
<H2><SPAN class="mw-headline" id="Diagnosis">Diagnosis</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=9" title="Edit section: Diagnosis">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<H3><SPAN class="mw-headline" id="Differential_diagnoses">Differential diagnoses</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=10" title="Edit section: Differential diagnoses">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H3>
<UL>
<LI><A href="/wiki/Disseminated_intravascular_coagulation" title="Disseminated intravascular coagulation">Disseminated intravascular coagulation</A></LI>
<LI><A href="/wiki/Hemolytic_anemia" title="Hemolytic anemia">Hemolytic anemia</A></LI>
<LI><A href="/wiki/Pulmonary_edema" title="Pulmonary edema">Pulmonary edema</A></LI>
<LI><A href="/wiki/Septic_shock" title="Septic shock">Septic shock</A></LI>
</UL>
<H2><SPAN class="mw-headline" id="Management">Management</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=11" title="Edit section: Management">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<UL>
<LI>In case of antibody-mediated acute hemolytic transfusion reactions,
<UL>
<LI>Immediately discontinue the transfusion while maintaining venous access for emergency management.</LI>
<LI>Anticipate low blood pressure, kidney failure, and DIC.</LI>
<LI>Prophylactic measures to reduce the risk of renal failure may include low-dose <A href="/wiki/Dopamine" title="Dopamine">dopamine</A>, vigorous hydration with intravenous crystalloid solutions (e.g., <A href="/wiki/Lactated_Ringer%27s_solution" class="mw-redirect" title="Lactated Ringer's solution">lactated Ringer's solution</A> or <A href="/wiki/Normal_saline" class="mw-redirect" title="Normal saline">normal saline</A>), and osmotic diuresis with <A href="/wiki/Mannitol" title="Mannitol">mannitol</A>.</LI>
<LI>If DIC is documented and bleeding requires treatment, transfusions of frozen plasma, pooled cryoprecipitates for fibrinogen, and/or platelet concentrates may be indicated.</LI>
</UL>
</LI>
<LI>In case of non-antibody mediated AHR
<UL>
<LI>This does not require rigorous management.</LI>
<LI>Diuresis induced by an infusion of normal saline until the intense red color of hemoglobinuria ceases is usually adequate treatment.<SUP id="cite_ref-8" class="reference"><A href="#cite_note-8">[8]</A></SUP></LI>
</UL>
</LI>
</UL>
<H2><SPAN class="mw-headline" id="Prognosis">Prognosis</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=12" title="Edit section: Prognosis">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<P>The major complication is that the hemoglobin, released by the destruction of red blood cells, may cause acute kidney failure (also known as the "oliguric phase"). About 20 deaths occur annually in the US due to AHTR.<SUP id="cite_ref-urlComplications_of_Transfusion:_Transfusion_Medicine:_Merck_Manual_Professional2_9-0" class="reference"><A href="#cite_note-urlComplications_of_Transfusion:_Transfusion_Medicine:_Merck_Manual_Professional2-9">[9]</A></SUP></P>
<H2><SPAN class="mw-headline" id="Epidemiology_2">Epidemiology</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=13" title="Edit section: Epidemiology">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<UL>
<LI>Acute hemolytic, immune mediated (fatal)-1 per 250,000-600,000</LI>
<LI>Acute hemolytic, immune mediated (nonfatal)-1 per 6000-33,000</LI>
<LI>Acute hemolytic, nonimmune-Infrequent</LI>
</UL>
<H2><SPAN class="mw-headline" id="References">References</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Acute_hemolytic_transfusion_reaction&action=edit&section=14" title="Edit section: References">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<DIV class="reflist columns references-column-width" style="-moz-column-width: 30em; -webkit-column-width: 30em; column-width: 30em; list-style-type: decimal;">
<OL class="references">
<LI id="cite_note-pmid15373591-1"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-pmid15373591_1-0"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><CITE class="citation journal">Covin RB, Evans KS, Olshock R, Thompson HW (2001). "Acute hemolytic transfusion reaction caused by anti-Coa". <I>Immunohematology</I>. <B>17</B> (2): 45–9. <A href="/wiki/PubMed_Identifier" class="mw-redirect" title="PubMed Identifier">PMID</A> <A rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/15373591">15373591</A>.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Immunohematology&rft.atitle=Acute+hemolytic+transfusion+reaction+caused+by+anti-Coa&rft.volume=17&rft.issue=2&rft.pages=45-9&rft.date=2001&rft_id=info%3Apmid%2F15373591&rft.aulast=Covin&rft.aufirst=RB&rft.au=Evans%2C+KS&rft.au=Olshock%2C+R&rft.au=Thompson%2C+HW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAcute+hemolytic+transfusion+reaction" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN></SPAN></LI>
<LI id="cite_note-2"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-2"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><CITE class="citation book">Hoffbrand, A. V.; P.A.H. Moss; J.E. Pettit (2006). <I><A href="/w/index.php?title=Essential_Haematology:_5th_Edition&action=edit&redlink=1" class="new" title="Essential Haematology: 5th Edition (page does not exist)">Essential Haematology: 5th Edition</A></I>. <A href="/wiki/Blackwell_Publishing" class="mw-redirect" title="Blackwell Publishing">Blackwell Publishing</A>. <A href="/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</A> <A href="/wiki/Special:BookSources/1-4051-3649-9" title="Special:BookSources/1-4051-3649-9">1-4051-3649-9</A>.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Essential+Haematology%3A+5th+Edition&rft.pub=Blackwell+Publishing&rft.date=2006&rft.isbn=1-4051-3649-9&rft.aulast=Hoffbrand&rft.aufirst=A.+V.&rft.au=P.A.H.+Moss&rft.au=J.E.+Pettit&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAcute+hemolytic+transfusion+reaction" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN></SPAN></LI>
<LI id="cite_note-pmid-3"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-pmid_3-0"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><CITE class="citation journal">Molthan L, Matulewicz TJ, Bansal-Carver B, Benz EJ (1984). "An immediate hemolytic transfusion reaction due to anti-C and a delayed hemolytic transfusion reaction due to anti-Ce+e: hemoglobinemia, hemoglobinuria and transient impaired renal function". <I>Vox Sang</I>. <B>47</B> (5): 348–53. <A href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</A>:<A rel="nofollow" class="external text" href="//doi.org/10.1111%2Fj.1423-0410.1984.tb04138.x">10.1111/j.1423-0410.1984.tb04138.x</A>. <A href="/wiki/PubMed_Identifier" class="mw-redirect" title="PubMed Identifier">PMID</A> <A rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/6438912">6438912</A>.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Vox+Sang.&rft.atitle=An+immediate+hemolytic+transfusion+reaction+due+to+anti-C+and+a+delayed+hemolytic+transfusion+reaction+due+to+anti-Ce%2Be%3A+hemoglobinemia%2C+hemoglobinuria+and+transient+impaired+renal+function&rft.volume=47&rft.issue=5&rft.pages=348-53&rft.date=1984&rft_id=info%3Adoi%2F10.1111%2Fj.1423-0410.1984.tb04138.x&rft_id=info%3Apmid%2F6438912&rft.aulast=Molthan&rft.aufirst=L&rft.au=Matulewicz%2C+TJ&rft.au=Bansal-Carver%2C+B&rft.au=Benz%2C+EJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAcute+hemolytic+transfusion+reaction" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN></SPAN></LI>
<LI id="cite_note-:2-4"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-:2_4-0"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><CITE class="citation web"><A rel="nofollow" class="external text" href="https://www.hhs.gov/ash/bloodsafety/2011-nbcus.pdf">"The 2011 National Blood Collection and Utilization Survey Report"</A> <SPAN style="font-size:85%;">(PDF)</SPAN>. Department of Health and Human Services<SPAN class="reference-accessdate">. Retrieved <SPAN class="nowrap">21 January</SPAN> 2016</SPAN>.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+2011+National+Blood+Collection+and+Utilization+Survey+Report&rft.pub=Department+of+Health+and+Human+Services&rft_id=https%3A%2F%2Fwww.hhs.gov%2Fash%2Fbloodsafety%2F2011-nbcus.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAcute+hemolytic+transfusion+reaction" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN></SPAN></LI>
<LI id="cite_note-:1-5"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-:1_5-0"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><CITE class="citation book">Bolton-Maggs, PHB; Poles, D; et al. (The Serious Hazards of Transfusion (SHOT) Steering Group) (2015). <A rel="nofollow" class="external text" href="http://www.shotuk.org/wp-content/uploads/report-2014.pdf"><I>The 2014 Annual SHOT Report (2015)</I></A> <SPAN style="font-size:85%;">(PDF)</SPAN>. SHOT. <A href="/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</A> <A href="/wiki/Special:BookSources/978-0-9558648-7-2" title="Special:BookSources/978-0-9558648-7-2">978-0-9558648-7-2</A>.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+2014+Annual+SHOT+Report+%282015%29&rft.pub=SHOT&rft.date=2015&rft.isbn=978-0-9558648-7-2&rft.aulast=Bolton-Maggs&rft.aufirst=PHB&rft.au=Poles%2C+D&rft_id=http%3A%2F%2Fwww.shotuk.org%2Fwp-content%2Fuploads%2Freport-2014.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAcute+hemolytic+transfusion+reaction" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN></SPAN></LI>
<LI id="cite_note-LauraDean-6"><SPAN class="mw-cite-backlink">^ <A href="#cite_ref-LauraDean_6-0"><SPAN class="cite-accessibility-label">Jump up to: </SPAN><SUP><I><B>a</B></I></SUP></A> <A href="#cite_ref-LauraDean_6-1"><SUP><I><B>b</B></I></SUP></A></SPAN> <SPAN class="reference-text"><CITE class="citation book">Laura, Dean (2005). <A rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/books/NBK2261/"><I>Blood Groups and Red Cell Antigens</I></A>. Bethesda, United States: National Center for Biotechnology Information<SPAN class="reference-accessdate">. Retrieved <SPAN class="nowrap">4 October</SPAN> 2017</SPAN>.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Blood+Groups+and+Red+Cell+Antigens&rft.place=Bethesda%2C+United+States&rft.pub=National+Center+for+Biotechnology+Information&rft.date=2005&rft.aulast=Laura&rft.aufirst=Dean&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK2261%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAcute+hemolytic+transfusion+reaction" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN></SPAN></LI>
<LI id="cite_note-7"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-7"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><CITE class="citation book"><I>Harrison's Principles of Internal Medicine</I> (18th ed.). p. 954.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Harrison%27s+Principles+of+Internal+Medicine&rft.pages=954&rft.edition=18th&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAcute+hemolytic+transfusion+reaction" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN></SPAN></LI>
<LI id="cite_note-8"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-8"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><CITE class="citation web"><A rel="nofollow" class="external text" href="http://emedicine.medscape.com/article/206885-overview">"Transfusion Reactions"</A><SPAN class="reference-accessdate">. Retrieved <SPAN class="nowrap">19 November</SPAN> 2012</SPAN>.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Transfusion+Reactions&rft_id=http%3A%2F%2Femedicine.medscape.com%2Farticle%2F206885-overview&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAcute+hemolytic+transfusion+reaction" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN></SPAN></LI>
<LI id="cite_note-urlComplications_of_Transfusion:_Transfusion_Medicine:_Merck_Manual_Professional2-9"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-urlComplications_of_Transfusion:_Transfusion_Medicine:_Merck_Manual_Professional2_9-0"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><CITE class="citation web"><A rel="nofollow" class="external text" href="http://www.merck.com/mmpe/sec11/ch146/ch146e.html#sec11-ch146-ch146d-1082">"Complications of Transfusion: Transfusion Medicine: Merck Manual Professional"</A>.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Complications+of+Transfusion%3A+Transfusion+Medicine%3A+Merck+Manual+Professional&rft_id=http%3A%2F%2Fwww.merck.com%2Fmmpe%2Fsec11%2Fch146%2Fch146e.html%23sec11-ch146-ch146d-1082&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAcute+hemolytic+transfusion+reaction" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN></SPAN></LI>
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<LI><A href="/wiki/Transfusion_hemosiderosis" title="Transfusion hemosiderosis">Transfusion hemosiderosis</A></LI>
<LI><A href="/wiki/Transfusion_related_acute_lung_injury" class="mw-redirect" title="Transfusion related acute lung injury">TRALI</A></LI>
<LI><A href="/wiki/Transfusion_associated_circulatory_overload" title="Transfusion associated circulatory overload">TACO</A></LI>
<LI><A href="/wiki/Transfusion-associated_graft_versus_host_disease" class="mw-redirect" title="Transfusion-associated graft versus host disease">TA-GvHD</A></LI>
<LI><A href="/wiki/Febrile_non-hemolytic_transfusion_reaction" title="Febrile non-hemolytic transfusion reaction">FNHTR</A></LI>
<LI><A class="mw-selflink selflink">Acute</A>/<A href="/wiki/Delayed_hemolytic_transfusion_reaction" title="Delayed hemolytic transfusion reaction">Delayed hemolytic transfusion reaction</A></LI>
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document_title: Acute hemolytic transfusion reaction

token: Acute

token: hemolytic

token: transfusion

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token: occurs

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token: can

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token: few

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question_text: what happens to the rbc in acute hemolytic reaction