Hemolytic Transfusion Reaction Occurring in a Patient with Acute Renal Failure

An acute hemolytic transfusion reaction due to ABO-incompatibility occurred in a patient during the fifth week of oliguria secondary to post-traumatic acute renal failure. Resort to "plasma-exchange" transfusion to reduce the high level of free hemoglobin in the circulation was considered and rejected. Sequential measurements of free and haptoglobin-bound hemoglobin documented rapid disappearance of both components from the patient’s plasma in the absence of hemoglobinuria. Within one week, the patient entered the diuretic phase, and ultimately stabilized at normal levels of urine volume, with a creatinine clearance of 53 ml per minute. The implications of free hemoglobinemia in the oliguric phase of acute renal failure are discussed.