Which signs, symptoms, and laboratory test results may indicate hemolysis?

Signs and symptoms that are not restricted to hemolytic transfusion reactions but may indicate hemolysis include:

  • hypotension
  • burning along site of infusion
  • severe low back pain
  • oliguria/anuria
  • uncontrolled bleeding (due to disseminated intravascular coagulation)
  • in the anesthetized patient, the only signs may be unexplained bleeding, falling blood pressure, and fever

Laboratory indicators of hemolysis include

  • positive DAT (with mixed-field agglutination that is not always easily detectable)
  • unexplained marked fall in hematocrit
  • unexplained marked fall in hemoglobin
  • hemoglobinemia
  • hemoglobinuria
  • severe bilirubinemia