Alloimmunization From Transfusions Differential Diagnoses

Updated: Sep 08, 2017
  • Author: Douglas Blackall, MD, MPH; Chief Editor: Michael A Kaliner, MD  more...
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Diagnostic Considerations

Delayed hemolytic transfusion reactions

Immune hemolysis

  • Paroxysmal nocturnal hemoglobinuria

  • Warm autoimmune hemolytic anemia

  • Cold agglutinin disease

  • Paroxysmal cold hemoglobinuria

Nonimmune hemolysis

  • Sepsis (particularly clostridial species), malaria, babesiosis

  • Mechanical hemolysis (eg, prosthetic valve, left ventricular assist device, small phlebotomy needles, infusion pumps, other devices)

  • Infusion of incompatible solutions together with RBC units

  • Accidental freezing or excessive heating of RBC units

  • Microangiopathic hemolytic anemia

  • Drug-induced hemolysis

  • Congenital hemolytic anemia (eg, glucose-6-phosphate dehydrogenase deficiency, hereditary spherocytosis)

Reabsorption of hematoma (eg, high lactate dehydrogenase or bilirubin, low haptoglobin)

Refractoriness to platelet transfusions

Before attempting to identify the cause of platelet refractoriness, ensure that the patient has been transfused with an adequate dose of ABO-compatible platelets. [10, 11]

Common nonalloimmune causes of inadequate response to an adequate dose of platelets include the following: [12]

Differential Diagnoses