patient suspected to having a hemolytic transfusion reactio

Discussion in 'MRCS Forum' started by Lona., Oct 26, 2007.

  1. Lona.

    Lona. Guest

    This patient suspected to having a hemolytic transfusion reaction should be managed with-
    a- Removal of nonessential foreign body irritants, e.g. Foley catheter
    b- Fluid restriction
    c- 0.1 M HCI infusion
    d- Steroids
    e- Fluids and mannitol
  2. Lona.

    Lona. Guest

    Answer: e- Fluids and mannitol. (Sabiston, 15/e, pp 124) Hemolytic transfusion reactions lead to hypotension and oliguria. The increased hemoglobin in the plasma will be cleared via the kidneys, which leads to hemoglobinuria. Placement of an indwelling Foley catheter with subsequent demonstration of oliguria and hemoglobinuria not only confirms the diagnosis of a hemolytic transfusion reaction but is useful in monitoring corrective therapy. Treatment begins with discontinuation of the transfusion, followed by aggressive fluid resuscitation to support the hypotensive episode and increase urine output. Inducing diuresis through aggressive fluid resuscitation and osmotic diuretics is important to clear the hemolyzed red cell membranes, which can otherwise collect in glomeruli and cause renal damage. Alkalinization of the urine (pH > 7) helps prevent hemoglobin clumping and renal damage. Steroids do not have a role in the treatment of hemolytic transfusion

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