Acute Transfusion Reactions

Question 1

Symptoms of AIHTR

Answer 1

Fever/chills
Back pain
Hemoglobinemia
Hemoglobinuria
Hypotension,
renal failure
Shock DIC

Question 2

Diagnosis of AIHTR

Answer 2

DAT positive
⬇️ Hemoglobin
⬆️ LDH
⬆️ Bilirubin
⬇️ Haptoglobin

Question 3

Treatment of AIHTR

Answer 3

Discontinue transfusion
Maintain vascular access
Maintain blood pressure
Maintain renal blood flow
Treat DIC if present

Question 4

Prevention of AIHTR

Answer 4

Follow standard operating procedures for identification of the patient

Question 5

Symptoms of ANIHTR

Answer 5

Asymptomatic
Hemoglobinuria

Question 6

Diagnosis of ANIHTR

Answer 6

DAT negative

Question 7

Treatment of ANIHTR

Answer 7

Discontinue transfusion
Maintain vascular access
Maintain renal blood flow

Question 8

Prevention of ANIHTR

Answer 8

Follow standard operating procedures for equipment operation

Question 9

Symptoms of TAS

Answer 9

Fever/chills
Hypotension
Shock

Question 10

Diagnosis of TAS

Answer 10

DAT negative
Gram stain blood bag
Culture blood bag
Culture patient

Question 11

Treatment of TAS

Answer 11

Discontinue transfusion
Maintain vascular access
Consider initial broad-spectrum antibiotic coverage

Question 12

Prevention of TAS

Answer 12

Follow standard operating procedures for collection
Implement bacterial detection intervention prior to transfusion

Question 13

Symptoms of FNHTR

Answer 13

Fever/chills
Nausea/vomiting
Tachycardia
Tachypnea
⬆️ Blood pressure

Question 14

Diagnosis of FNHTR

Answer 14

DAT negative

Question 15

Treatment of FNHTR

Answer 15

Treat with antipyretics
For rigors, treat with meperidine

Question 16

Prevention of FNHTR

Answer 16

Prestorage leukoreduction of PRBC and platelets

Question 17

Symptoms of Allergic Mild

Answer 17

Erythema
Pruritus

Question 18

Diagnosis of Allergic Mild

Answer 18

Clinical diagnosis
DAT not required

Question 19

Treatment of Allergic Mild

Answer 19

Temporary discontinue transfusion
Treat with antihistamines
If symptoms improve restart transfusion

Question 20

Prevention of Allergic Mild

Answer 20

For repeated reactions, consider premedication with antihistamines

Question 21

Symptoms of Allergic Severe

Answer 21

Angioedema
Wheezing
Hypotension
Anaphylaxis

Question 22

Diagnosis of Allergic Severe

Answer 22

DAT negative
IgA deficiency workup when indicated

Question 23

Tx of Allergic Severe

Answer 23

Discontinue transfusion
Maintain vascular access
Treat with subcutaneous epinephrine
Maintain blood pressure
Provide respiratory support

Question 24

Allergic Severe

PREVENTION

Answer 24

For IgA absolute deficient patients provide IgA
deficient blood components

Question 25

TRALI

SYMPTOMS

Answer 25

Severe hypoxemia
No evidence of left atrial hypertension

Question 26

TRALI

DIAGNOSIS

Answer 26

CXR: bilateral infiltrates
Donor test for HLA/HNA antibodies
Recipient test for
HLA/HNA antigens

Question 27

TRALI

TREATMENT

Answer 27

Discontinue transfusion
Maintain vascular access
Supplemental oxygen
Mechanical ventilation

Question 28

TRALI

PREVENTION

Answer 28

Use male only plasma
Exclude or screen female platelet donors

Question 29

TACO

SYMPTOMS

Answer 29

Severe hypoxemia
⬆️ Blood pressure
Jugular vein distension
⬆️ Central venous pressure

Question 30

TACO

DIAGNOSIS

Answer 30

CXR: pulmonary edema,
cardiomegaly,
distended pulmonary artery
BNP

Question 31

TACO

TREATMENT

Answer 31

Upright posture
Supplemental oxygen
Diuresis

Question 32

TACO

PREVENTION

Answer 32

Slower transfusion rate
Transfuse in smaller volumes