What measures are included in preventing hemolytic reactions?

In general, preventive measures for hemolytic reactions include strict verification of blood type and blood bag information, standardized blood storage and transportation, prevention of blood contamination, control of transfusion rate, and assessment of the patient's individual risk for hemolysis. Specific details are as follows:

1. Strict Verification of Blood Type and Blood Bag Information

Prior to transfusion, the patient’s name, blood type, hospital number, and the blood bag’s blood type and identification number must be repeatedly verified to ensure complete consistency. Infusing blood with an incompatible blood type can lead to red blood cells being attacked by antibodies in the recipient's body, resulting in hemolysis. Careful verification helps prevent such errors at the source and reduces the likelihood of hemolytic reactions.

2. Standardized Blood Storage and Transportation

Blood must be stored in refrigerators maintained at specified temperatures, and during transport, it should remain cold and protected from severe shaking. Low temperatures help preserve red blood cell viability, while vigorous agitation may damage red blood cell structure, causing premature rupture. Transfusion of such damaged blood can easily trigger non-immune-mediated hemolytic reactions. Proper storage and transport protect red blood cell integrity.

3. Prevention of Blood Contamination

Sterile techniques must be strictly followed during blood collection and transfusion. Sterile instruments should be used, and the site of operation must be disinfected. If blood becomes contaminated with bacteria or other microorganisms, microbial metabolic byproducts may damage red blood cells and simultaneously cause infection. These dual factors increase the risk of hemolytic reactions. Aseptic procedures effectively block contamination pathways.

4. Control of Transfusion Rate

The initial phase of transfusion should be administered slowly—typically 10–20 drops per minute for the first 15 minutes. After confirming no adverse reactions, the rate may be adjusted accordingly. Rapid transfusion introduces a large number of red blood cells into the body within a short time. In patients with compromised circulatory function, this may lead to intravascular aggregation and rupture of red blood cells. Slow infusion allows the body time to adapt, thereby reducing the risk of hemolysis.

5. Assessment of Patient-Specific Hemolysis Risk

A thorough medical history should be obtained before transfusion, including conditions such as glucose-6-phosphate dehydrogenase (G6PD) deficiency (favism) or autoimmune hemolytic anemia. Patients with these conditions may have inherently defective red blood cells or autoantibodies that destroy red blood cells. Even transfusion with compatible blood types may trigger or exacerbate hemolytic reactions. Early identification enables tailored transfusion strategies to minimize risks.

In addition, vital signs—including body temperature, blood pressure, and urine output—should be closely monitored during transfusion. If symptoms such as chills, back pain, or darkened urine occur, the transfusion must be stopped immediately and appropriate interventions initiated. Furthermore, enhanced training on transfusion-related knowledge is necessary to improve healthcare providers’ adherence to clinical protocols.