A 39-year-old man is undergoing resuscitation with blood products for an upper GI bleed. He is suspected of having a hemolytic transfusion reaction. Which of the following is appropriate in the management of this patient?
Hemolytic transfusion reactions lead to hypotension and oliguria. The increased hemoglobin in the plasma will be cleared 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 suppo the hypotensive episode and increase urine output. Inducing diuresis through aggressive fluid resuscitation and osmotic diuretics is impoant 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 reactions.
Removal of nonessential foreign body irritants, for example, Foley catheter
Fluid restriction
0.1 M HCl infusion
Fluids and mannitol
Preoperative assessment and monitoring in anaesthesia