Acute non-haemolytic reactions during transfusions

Question 1

What is the presentation of a non-haemolytic febrile reaction to blood transfusions?

Answer 1

• Fever, chills
• Affects 1-2% of patients
• Usually develop towards end of transfusion or in subsequent 2 hours

Question 2

What is the management of non-haemolytic febrile reaction to a blood transfusion?

Answer 2

• Slow or stop transfusion
• Paracetamol
• Monitor

Question 3

What is the presentation of a minor allergic reaction to a blood transfusion?

Answer 3

• Pruritus

* Urticaria

Question 4

What is the management of minor allergic reactions to a blood transfusion?

Answer 4

• Temporarily stop the transfusion
• Antihistamine
• Monitor

Question 5

What is the presentation of anaphylaxis due to blood trasfusion?

Answer 5

• immediate -after only 5-10ml given
• Hypotension
• Dyspnoea
• Wheezing
• Angioedema

Question 6

What is the management of anaphylaxis due to a blood transfusion?

Answer 6

• Stop the transfusion
• IM adrenaline 0.5mg 1:1000
• ABC support

Question 7

What is the presentation of transfusion-associated circulatory overload?

Answer 7

*Pulmonary oedema
*Hypertension
=due to excessive rate of transfusion or pre-existing heart failure

Question 8

What is the management of transfusion-associated circulatory overload?

Answer 8

• Slow or stop transfusion

* Consider IV loop diuretic e.g. furosemide + oxgen

Question 9

What is transfusion related acute lung injury (TRALI)?

Answer 9

Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood

Question 10

What is the presentation of transfusion related acute lung injury (TRALI)?

Answer 10

• Hypoxia
• Pulmonary infiltrates on CXR
• Hypotension
• Followed within 6hours of transfusion

Question 11

What is the management of transfusion related acute lung injury?

Answer 11

• Stop the transfusion
• Oxygen
• Supportive care

Question 12

What infection can be transmitted via blood transfusion?

Answer 12

vCJD

Question 13

What types of blood products are there?

Answer 13

• Packed Red cells
• Platelets
• Fresh frozen plasma

Question 14

What are packed red cells used for?

Answer 14

• Acute blood loss

* Chronic anaemic

Question 15

What does fresh frozen plasma contain? Used for?

Answer 15

• Clotting factors, albumin and immunoglobulin

* Sued for correcting clotting deficiencies in patients with hepatic synthetic failure who are to undergo surgery

Question 16

What are platelet transfusions used for?

Answer 16

*Thrombocytopaenic patients who are bleeding or who require surgery

Question 17

How much is 1 unit for a transfusions?

Answer 17

250 - 270ml

Question 18

What is acute haemolytic reaction after a blood transfusion?

Answer 18

*ABO incompatible blood e.g. secondary to human error

Question 19

What is the presentation of acute haemolytic reaction after a blood transfusion?

Answer 19

• Symptoms begin minutes after transfusion is started
• Fever
• Abdo Pain
• Hypotension
• Chest pain
• Agitation
• Complications include DIC and renal failure

Question 20

What is the management of acute haemolytic reaction from a blood transfusion?

Answer 20

*Stop transfusion
*Confirm diagnosis
>Check identity of patient/name of blood product
>Send blood for direct Coombs test, repeat typing and cross-matching
*Fluid resus