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Figure 1: Management and blood bank investigation of a suspected transfusion reaction. Specific therapeutic interventions should be based on the recipient's signs, symptoms and underlying medical condition. *Transfusion can only be started after the recipient's identity is verified and matches the information on the blood unit. If a transfusion reaction is suspected, the clinical staff should repeat this verification. The blood bank will also compare the identifiers on the returned unit with that on the accompanying documentation to verify that the correct patient received the unit. 
Identifies whether hemolysis, mediated by IgG or complement, has occurred. In most blood banks, this test is performed on the post-reaction specimen and, if positive, is also performed on a pre-transfusion sample for comparison. 
Visual inspection for colour change is a sensitive test that can detect small amounts of free hemoglobin in the plasma. This test complements the direct antiglobulin test and may be the only indicator of hemolysis if the antibody or complement-coated red blood cells were rapidly cleared from the patient's circulation (resulting in a negative result of a direct antigen test despite the presence of immune-mediated hemolysis). 
Although post-transfusion urine samples may be difficult to obtain, the presence of free hemoglobin in the urine indicates the presence of a large amount of free hemoglobin in the plasma, which exceeds the binding capacity of circulating haptoglobin.
