From the Blood Bank Guy Site -
http://www.bbguy.org/index.htm
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Acute Hemolytic Reactions
Unfortunately, the majority of Acute HTRs are explained by one very simple and blunt sentence: Someone screwed up! It is really a sad reality that even today, in 1999, the way that we harm folks the most in transfusion is through someone making a silly mistake. Before you start clucking your tongue at the nurses, by the way, you should know that about 1/3 of these mistakes occur in the Blood Bank, according to the classic study by Sazama summarizing transfusion-related deaths reported to the FDA (TRANSFUSION 1990;30:583-590).
What kind of mistakes am I referring to? You name it. Anything from mixing up specimen labels to incorrectly labeled samples to issuing the wrong unit for the wrong patient to transfusing the right unit to the wrong patient can potentially give you hemolysis, most commonly due to an ABO mismatch. Statistically, the most common place where the process breaks down is at the point of actual administration (57%, according to the above study).
Lest we be incomplete, I should remind you that things other than identification or administration error and ABO mismatch can cause acute HTRs. Other blood group incompatibilities (most notably with Rh antibodies like D, E, and c, and Kell antibodies), faulty blood warmers, infusing blood with a hypotonic solution like 0.45% normal saline, and a variety of other mechanical problems can potentially cause acute hemolysis. Fortunately, though, the "other" methods of acute hemolysis usually do not have the devastating consequences typical of an ABO mismatch.
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