Investigating non-immune haemolytic transfusion reactions in surgical patients

Objective To perform a Root Cause Analysis (RCA) to identify the cause for Acute Haemolytic Transfusion Reaction (AHTR) in five patients who received red cell transfusions. Background The occurrence of red coloured urine following blood transfusion carries the possibility of an immune or non-immune mediated haemolytic transfusion reaction (HTR). Non-immune haemolysis can be due to thermal, osmotic, or mechanical injury to red blood cells. The authors report five cases of non-immune HTR that occurred in surgical patients in the peri-operative period. Methods AHTR was reported to the Transfusion Medicine Department, in five patients who underwent surgery and received a blood transfusion in the peri-operative period. Transfusion reaction workup and RCA were performed to identify the cause for AHTR. Results The initial presentation was red coloured urine and suspicion of an immune HTR. Immunohaematology workup ruled out an immune mediated haemolysis and further analysis revealed the possibility of mechanical red cell destruction in all these cases. Conclusion Multiple factors can result in non-immune destruction of red cells. Possibility of non-immune haemolysis should be considered while evaluating haemolytic transfusion reactions.