Definitions:
Acute haemolytic transfusion reactions (AHTR) are characterised by fever, a fall in haemoglobin (Hb), rise in bilirubin and lactate dehydrogenase (LDH) and a positive direct antiglobulin test (DAT). They generally present within 24 hours of transfusion.
Delayed haemolytic transfusion reactions (DHTR), occur more than 24 hours following a transfusion and are associated with a fall in Hb or failure to increment, rise in bilirubin and LDH and an incompatible crossmatch not detectable pre transfusion.
Hyperhaemolysis (HH) is characterised by more severe haemolysis than DHTR, with haemolysis affecting the transfused red cells and the patient’s own red cells; there is a decrease in Hb to below pre-transfusion levels, which is often associated with a reticulocytopenia. It may be triggered by a new red cell alloantibody, but frequently no new red cell antibody is identified. Hyperhaemolysis can be divided into acute and delayed hyperhaemolysis.
SHOT has collected data on haemolytic transfusion reactions (HTR) since 1996. Until 2006, this category only included delayed HTR, as acute reactions were reported under the ATR category. Alloimmunisations are not included within the numbers in the figure above.
Recent Recommendations
Effective communication is vital to maintain transfusion safety, this includes communicating the reasons for, and risks of transfusion to the patient, communication between clinical areas and communication between hospitals
Action: All staff involved in transfusion
Provide as much information as possible to SHOT when reporting, including the investigations performed, treatment modality and patient outcome
Action: Haemovigilance reporters
Do not withhold lifesaving transfusion, even if the patient has a history of alloantibodies, and carefully monitor the patient for signs and symptoms of a haemolytic transfusion reaction
Action: Clinical staff involved in transfusion
Laboratory protocols should include a full investigation for HTR which might include referring samples when resources for testing are not available locally
Action: Laboratory staff involved in transfusion
HTR Resources
SHOT Bite No. 15: Hyperhaemolysis
HTR Annual Report Chapters
Haemolytic Transfusion Reactions (HTR) 2023
Haemolytic Transfusion Reactions (HTR) 2022
Haemolytic Transfusion Reactions (HTR) 2021
Haemolytic Transfusion Reactions (HTR) 2020
Haemolytic Transfusion Reactions (HTR) 2019
Haemolytic Transfusion Reactions (HTR) 2018
Haemolytic Transfusion Reactions (HTR) 2017
Haemolytic Transfusion Reactions (HTR) 2016
Haemolytic Transfusion Reactions (HTR) 2015
Haemolytic Transfusion Reactions (HTR) 2014
Haemolytic Transfusion Reactions (HTR) 2013
Haemolytic Transfusion Reactions (HTR) 2012
Haemolytic Transfusion Reactions (HTR) and Alloimmunisation 2011
Haemolytic Transfusion Reactions (HTR) 2010
Haemolytic Transfusion Reactions (HTR) 2009
Haemolytic Transfusion Reactions (HTR) 2008
Haemolytic Transfusion Reactions (HTR) 2007
Haemolytic Transfusion Reactions (HTR) 2006
Haemolytic Transfusion Reactions (HTR) 2005
Haemolytic Transfusion Reactions (HTR) 2004
Haemolytic Transfusion Reactions (HTR) 2003
Haemolytic Transfusion Reactions (HTR) 2001-02
Haemolytic Transfusion Reactions (HTR) 2000-01
Haemolytic Transfusion Reactions (HTR) 1999-00
Haemolytic Transfusion Reactions (HTR) 1998-99