Acute Post Transfusion Hemolysis

So a recently transfused patient presents with Acute Renal Failure, low BP, Pruritus and so on and so forth. An emergency life threatening situation. So how'd you treat? Any emergency situation, list out the patient's pathologies and prioritize them in decreasing order of how life threatening they are to the patient.

The patient's problems are: The post transfusion hemolysis itself, and its complications: Acute Renal Failure and low BP & hypoperfusive shock.

Treat the low BP first : Cardiac inotropes - Dopamine is probably ideal, with minimal renal effects; Rheopolyglucin

IV Fluids

Dialysis - If available : Probably the best option.

IV glucocorticosteroids

A suitable anticoagulant

Furosemide in high doses, to increase GFR*

Plasmapheresis if necessary


Edit: After a thorough dressing down by the mother, I realized that furosemide is contraindicated unless systolic BP > 100. So, furosemide only after BP is stabilized. Apologies for that boo-boo.

bilevel positive pressure ventilation (BiPAP) in CHF patients

diuresis is paramount in patients with CHF that have AFib. anti arrhythmic drugs can help bring down the rate, but would not ineffective minus diuresis (atrial stretch from fluid overload causes the patient to go into Afib).


a trial of BiPaP can go a long way in stabilizing the patient (decreases afterload, increases preload and increases CO) while you are awaiting the effects of diuresis.

did you know?

A hepatic abscess caused by Klebsiella, has an association with DM and septic endopthalmitis.