1. Acute renal failure from hemolytic transfusion reactions
Dr Mojgan Mortazavi
Associate professor of nephrology
Isfahan kidney Diseases research center

2. Acute hemolytic transfusion reaction
ABO incompatability is the major cause of death from transfusion
IgM anti-A and anti-B fix complement  rapid intravascular hemolysis
Acute renal failure from ATN
DIC
Shock
Hyperkalemia
Renal failure can be caused by direct toxicity of hemoglobin and by renal ischemia from shock

3. Acute transfusion reactions
Acute haemolytic transfusion reaction due to
ABO incompatible blood or bacterial contamination
difficult to differentiate clinically
causes:
acute intravascular haemolysis
shock
acute renal failure
DIC
extremely serious, can be fatal

4. Hemoglobinuria
Alpha-Beta dimers MW 34, small enough to be filtered by glomerulus

5. Proposed mechanisms of renal injury
1. Obstruction of tubules with heme pigment casts
2. Oxidative damage to proximal tubule by released free iro

6. Approach to the patient with red or brown urine
                                                                            
Electrolyte abnormalities 

7. AHTR: Symptoms & Signs Patient feels unwell and agitated Symptoms
Fever, rigors
Headache, SOB
Loin/back pain
Pain at infusion site
Signs
Hypotension
Reduced urine output  acute renal failure
Bleeding from venepuncture sites due to DIC
Urinalysis: haemoglobinuria

8. Management of AHTR A medical emergency: Stop transfusion immediately
Keep line open with N/Saline using new giving set
Monitor pulse, BP, temp
Call member of medical staff
Check identity of patient against blood bag
Take urgent blood samples:
FBC, cross-match, U & Es, clotting screen, blood cultures
Save any urine
Send blood unit back to the blood bank

9. Prevention of ARF
Volume repletion
Alkalinization of urine

10. MANAGEMENT
Plasma volume expansion with intravenous isotonic saline should be given as soon as possible, even while trying to establish the cause of the hemolysis.

11. Monitoring with serial measurements of serum potassium, calcium, phosphate, and creatinine ,LDH is recommended.

12. Late Treatment Dialysis – intermitted preferred to continuous
Reduce use of anticoagulants in trauma patients