Hemolysis

Definition

Hemolysis is the breakdown of red blood cells, releasing hemoglobin into circulation. It may be acute or chronic, intravascular or extravascular (splenic).

Causes

• Transfusion reactions (ABO incompatibility)
• Autoimmune hemolytic anemia
• Sickle cell crisis
• G6PD deficiency (with oxidative stressors)
• Mechanical: prosthetic valve, TTP, HELLP syndrome
• Infections (malaria, sepsis)
• Drugs (penicillin, quinidine)

Clinical Features

Fever, chills, flank pain, back pain, tachycardia, hypotension, dark red or tea-colored urine (hemoglobinuria), jaundice, elevated indirect bilirubin and LDH, low haptoglobin.

Nursing Interventions

For transfusion reaction: STOP transfusion immediately, maintain IV access with normal saline (new tubing), notify provider and blood bank, send blood bag and tubing for investigation, check vital signs every 15 minutes, monitor urine output, administer prescribed medications.

NCLEX Relevance

Hemolytic transfusion reaction: STOP transfusion first, then maintain access with saline.