(1) Commonly observed in premature infants with

NEC and/or sepsis (39)

(2) Suspect T-activation in neonates at risk with

intravascular hemolysis, hemoglobinuria, hemoglobinemia following transfusion of blood products, or unexpected failure to achieve posttransfusion hemoglobin increment.

(3) Routine cross-matching techniques will not

detect T-activation when monoclonal ABO antiserum is used.

(4) Diagnosis: Minor cross-match of neonatal

T-activated red cells with donor anti–Tcontaining serum, discrepancies in forward and

reverse blood grouping, confirmed by specific

agglutination tests using peanut lectins Arachis

hypogea and Glycine soja.

(5) Use washed red cells, platelets, and low-titer

anti-T plasma (if available) only when hemolysis is confirmed.

3. Nonimmunologic causes of hemolysis

a. Mechanical, through excessive infusion pressure

through small needles or 20- to 40-mm filters

b. Accidental overheating or freezing of blood

c. Simultaneous administration of incompatible drugs

and fluids

d. Transfusion of abnormal donor cells (glucose

6-phosphate dehydrogenase deficiency, hereditary

spherocytosis)

4. Other immunologic/nonimmunologic reactions

a. TA-GVHD (See processing with irradiation for risk

factors and prevention page 306)

(1) Seen 3 to 30 days following transfusion of a cellular component. Symptoms include fever; generalized, erythematous rash with/without progression to desquamation; diarrhea; hepatitis

(mild to fulminant liver failure); respiratory distress; and severe pancytopenia

(2) High mortality rate (80% to 100%)

b. TRALI:

(1) Secondary to transfusion of donor blood containing anti-HLA or neutrophil antibodies

directed against recipient leukocytes, causing

complement activation with microvascular lung

injury and capillary leak.

(2) Presents within 4 hours of transfusion with respiratory distress due to noncardiogenic pulmonary

Chapter 43 ■ Transfusion of Blood and Blood Products 313