Snap Shot A 75-year-woman has been in the hospital for 4 days for a lower GI bleed. Four units of blood have been administered over that four-day period. On the fifth day, after receiving a unit of blood she became dyspneic and had severe back pain. The transfusion was discontinued. Her temperture is 101.3 F, BP is 100/60, and a HR of 120/min and RR of 20/min. A foley catheter is draining reddish-brown urine. Introduction Group O patient (has Abs for A and B) receives type A or B blood leading to massive intravascular hemolysis A Type II hypersensitivity reaction Caused by clerical error mislabeled specimens reactions to antigens not routinely tested for Presentation Symptoms severe chills high grade fever back pain chest and abdominal pain dark urine May lead to respiratory distress and shock Treatment Stop transfusion and keep IV open with normal saline or Ringers lactate The unit of blood and a patient blood sample should be sent immediately to the transfusion center for workup If urine output decreases or there are signs of volume overload then add a loop diuretic (furosemide) If volume is stable then use mannitol instead to cause osmotic diuresis to prevent acute tubular necrosis