Hemolytic reaction after major and minor compatible blood transfusion for a cesarean section patient in a resource-limited area: A case report.

Abstract

Introduction: A hemolytic transfusion reaction is the destruction of red blood cells caused by immunological incompatibility between the donor and the recipient, not only incompatibility but also, rarely, compatible blood transfusion, which may cause a hemolytic transfusion reaction. A hemolytic transfusion reaction occurs when the transfusion causes symptoms as well as clinical or laboratory indicators of increased red cell death.

Patient presentation: We present the case of a 27-year-old Gravida II Para I mother who was blood group AB positive with anaemia, hypotension secondary to antepartum hemorrhage, and a mentally conscious mother who was transferred to our obstetric emergency operation theatre. As she experienced bleeding on arrival, we assessed the patient's history and performed anaesthesia-related physical examinations, such as cardiovascular examination, respiratory examination, central nerve system examination, and airway examination. We followed the patient postoperatively until discharge from the hospital, and 12.9 g/dl hemoglobin, 36.3 % haematocrit, 402 × 10³ platelet count, and 0.9 mg/dl creatinine were detected. After satisfactory postoperative vital signs and laboratory results were obtained, the patient was discharged from the hospital after 3 days.

Clinical discussion: Acute hemolytic transfusion is a medical emergency with an estimated frequency of one per 70,000 blood product transfusions and an estimated fatality rate of five per 10 million RBC unit transfusions. Importantly, the traditional triad of fever, flank pain, and red or dark urine is uncommon. However, these symptoms may not be immediately visible if the patient is under anaesthesia; in such circumstances, seeping from venipuncture and dark urine caused by DIC and hemoglobinuria, respectively, may be the only observations.

Conclusion: Blood transfusion is performed in 0.5-3 % of women with obstetric hemorrhage and accounts for 1 % of all transfused blood products in high-income countries. Anesthesiologists face a significant issue in identifying the necessity for transfusion in patients with obstetric hemorrhage. Hemolytic reactions after blood transfusion are common during emergency patient management. For this reason, the World Health Organization has developed guidelines for early detection and management.