Leo A, Pedal I
Institute for Clinical Transfusion Medicine and Cell Therapy Heidelberg, University of Heidelberg, Heidelberg, Germany.
Forensic Sci Med Pathol. 2010 Jun;6(2):135-45. doi: 10.1007/s12024-009-9115-7. Epub 2010 Feb 6.
The erroneous transfusion of ABO-incompatible red cells may lead to life-threatening hemolysis and complement-induced shock, resulting in death in less than 10% of cases (acute hemolytic transfusion reaction, AHTR). Identification of the cause of an erroneous transfusion is accomplished in nearly all incidents merely by checking the identity of the patient, blood sample and blood bag. The erroneous transfusion is confirmed by serological and--in the case of a fatality- immunohistochemical methods. The differential diagnosis should rule out transfusion-related acute lung injury (TRALI), other immunologically triggered causes such as febrile nonhemolytic transfusion reaction (FNHTR) or allergic reactions, but also nonimmunological causes such as bacterial contamination of the blood components, transfusion-associated circulatory overload (TACO) and other rare events such as citrate overload or embolism (by air or debris). In the case of a fatality, evaluation of a patient's medical records, serological and microbiological analyses, autopsy and histology, taken together, clarify questions of causality.
误输ABO血型不匹配的红细胞可能导致危及生命的溶血和补体介导的休克，不到10%的病例会因此死亡（急性溶血性输血反应，AHTR）。几乎在所有误输事件中，仅通过核对患者、血样和血袋的身份就能确定误输原因。通过血清学方法以及在发生死亡的情况下通过免疫组化方法来确认误输情况。鉴别诊断应排除输血相关急性肺损伤（TRALI）、其他免疫触发原因，如发热性非溶血性输血反应（FNHTR）或过敏反应，还要排除非免疫性原因，如血液成分的细菌污染、输血相关循环超负荷（TACO）以及其他罕见事件，如枸橼酸盐过量或栓塞（空气或碎片所致）。在发生死亡的情况下，综合对患者进行医学评估、血清学和微生物学分析、尸检及组织学检查，可明确因果关系问题。
