Cognitive Biases in Early Trauma Transfusions: Lessons From Three Rare Cases of Acute Hemolytic Reaction

Area of Science:

• Trauma Resuscitation
• Transfusion Medicine
• Patient Safety

Background:

• Massive transfusion protocols (MTPs) are critical for trauma care.
• MTPs may increase the risk of acute hemolytic transfusion reactions (AHTRs).
• ABO incompatibility is the primary cause of AHTRs, often overlooked in trauma.

Purpose of the Study:

• To describe cases of ABO-incompatible AHTR in trauma patients.
• To highlight diagnostic challenges and contributing factors.
• To emphasize the need for improved vigilance and protocols.

Main Methods:

• Case series of three trauma patients experiencing AHTR.
• Review of clinical presentations, transfusion records, and outcomes.
• Analysis of diagnostic delays and contributing factors, including cognitive biases.

Main Results:

• Three patients received ABO-incompatible blood, leading to severe complications.
• Hemolysis signs were initially attributed to trauma, delaying AHTR diagnosis.
• Outcomes included multiorgan failure and death in all three cases.

Conclusions:

• ABO-incompatible AHTR is a rare but potentially fatal complication in trauma.
• Overlapping symptoms with trauma and cognitive biases impede early recognition.
• Strict transfusion protocols, vigilance for persistent anemia, and awareness of cognitive errors are crucial.