A CA SE OF A BO - I NCOMPAT IBLE BLO OD TRA NSFUSION

T R EAT ED BY P L A SM A
EX CH A NG E T H ER A PY A ND CO NT I NUOUS
H EMODIAFILTRATIO N

B Y : A K I O N A M I K AWA · Y U KO S H I B U YA · H A R U K I O U C H I · H I R O KO
TA K A H A S H I · YO S H I TA K A F U R U TO
3 1 J A N U A RY 2 0 1 8
 ABSTRACT
ABO-incompatible blood transfusion is potentially a life-threatening event. A 74-year-old type O Rh-positive male was
accidentally transfused with 280 mL type B Rh-positive red blood cells during open right hemicolectomy, causing ABO incompatible blood
transfusion. Immediately after the transfusion, the patient experienced a hypotension episode followed
by acute hemolytic reaction, disseminated intravascular coagulation and acute kidney injury. Plasma exchange therapy was
performed to remove anti-B antibody and free hemoglobin because they caused acute hemolytic reaction, disseminated
intravascular coagulation, and acute kidney injury. Free hemoglobin levels decreased from 13 to 2 mg/dL for 2 h. Continuous
hemodiafltration was used to stabilize hemodynamics.The patient was successfully treated for acute hemolytic reaction,
disseminated intravascular coagulation, and acute kidney injury. Plasma exchange therapy and continuous hemodiafltration
are likely to be effective treatments for ABO-incompatible blood transfusion, and further studies are required to assess this
effectiveness in future.
INTRODUCTION

• ABO-incompatible blood transfusion often causes acute

hemolytic reaction followed by disseminated intravascular coagulation (DIC) and acute kidney
injury (AKI).
• The current treatment consists of prompt discontinuation of the blood
transfusion along with anti-DIC treatments, in cases of DIC.
• Plasma exchange therapy involves the replacement of
plasma in the blood with FFP or 5% albumin to remove toxic
substances in the plasma and supplement insufcient substances [17]. For incompatible blood
transfusions, plasma
exchange therapy results in the removal of anti-A or anti-B
antibodies and the removal of free hemoglobin.
• CHDF(continuous hemodiafiltration) may be a useful adjunct to stabilize hemodynamics during
incompatible blood transfusion, as it helped to avoid
volume overload
A. THE CHANGES IN THE ACUTE HEMOLYTIC REACTION AND THE AMOUNT
OF TRANSFUSION
B. T H E P R OGR ESSI O N O F D I S SEM I NATI O N I N T R AVASCUL AR C O A G UL ATI O N ( D I C)
C. T H E C H A NG ES O F F R E E H E M O G LO BI N A N D R E NA L F U N C T IO N
CHANGES IN THE COLOR OF PLASMA
CHANGES IN ANTI-B ANTIBODY LEVELS
CONCLUSION

• In conclusion, a case of incompatible blood transfusion successfully treated with plasma

exchange therapy and CHDF. This report shows that plasma exchange
therapy and CHDF are potentially useful for inhibiting the onset and progression of acute
hemolytic reactions, DIC, and AKI
ADDITIONAL:

• Plasma exchange with 5% albumin was effective for refractory Kawasaki disease. However, as
there was a possibility of coagulation disorder, attention should be given to changes in
coagulation factors like fibrinogen, especially in small patients who need frequent plasma
exchange.

• https://www.researchgate.net/publication/323584196_Safety_and_efficacy_of_plasma_exchang
e_therapy_for_Kawasaki_disease_in_children_in_intensive_care_unit_case_series