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Anaphylactic reactions are excluded by the presence of red plasma or urine, discordant pretransfusion and posttransfusion ABO blood types, or a positive direct antiglobulin (Coombs) test result. Demonstration of anti-IgA in a pretransfusion sample of the recipient's serum or plasma establishes the diagnosis.
In-vivo hemolysis can occur with certain disease conditions (autoimmune hemolytic anemia) or as a reaction to a transfusion. However, most often the hemolysis is the result of improper specimen collection and handling; prevention rests primarily with those doing the collection and initial processing of the specimen. Planning specimen collection carefully, establishing a correct process, and training in the process is critical.