Acute Transfusion Reactions Flashcards
Symptoms of AIHTR
Fever/chills
Back pain
Hemoglobinemia
Hemoglobinuria
Hypotension,
renal failure
Shock DIC
Diagnosis of AIHTR
DAT positive
⬇️ Hemoglobin
⬆️ LDH
⬆️ Bilirubin
⬇️ Haptoglobin
Treatment of AIHTR
Discontinue transfusion
Maintain vascular access
Maintain blood pressure
Maintain renal blood flow
Treat DIC if present
Prevention of AIHTR
Follow standard operating procedures for identification of the patient
Symptoms of ANIHTR
Asymptomatic
Hemoglobinuria
Diagnosis of ANIHTR
DAT negative
Treatment of ANIHTR
Discontinue transfusion
Maintain vascular access
Maintain renal blood flow
Prevention of ANIHTR
Follow standard operating procedures for equipment operation
Symptoms of TAS
Fever/chills
Hypotension
Shock
Diagnosis of TAS
DAT negative
Gram stain blood bag
Culture blood bag
Culture patient
Treatment of TAS
Discontinue transfusion
Maintain vascular access
Consider initial broad-spectrum antibiotic coverage
Prevention of TAS
Follow standard operating procedures for collection
Implement bacterial detection intervention prior to transfusion
Symptoms of FNHTR
Fever/chills
Nausea/vomiting
Tachycardia
Tachypnea
⬆️ Blood pressure
Diagnosis of FNHTR
DAT negative
Treatment of FNHTR
Treat with antipyretics
For rigors, treat with meperidine
Prevention of FNHTR
Prestorage leukoreduction of PRBC and platelets
Symptoms of Allergic Mild
Erythema
Pruritus
Diagnosis of Allergic Mild
Clinical diagnosis
DAT not required
Treatment of Allergic Mild
Temporary discontinue transfusion
Treat with antihistamines
If symptoms improve restart transfusion
Prevention of Allergic Mild
For repeated reactions, consider premedication with antihistamines
Symptoms of Allergic Severe
Angioedema
Wheezing
Hypotension
Anaphylaxis
Diagnosis of Allergic Severe
DAT negative
IgA deficiency workup when indicated
Tx of Allergic Severe
Discontinue transfusion
Maintain vascular access
Treat with subcutaneous epinephrine
Maintain blood pressure
Provide respiratory support
Allergic Severe
PREVENTION
For IgA absolute deficient patients provide IgA
deficient blood components
TRALI
SYMPTOMS
Severe hypoxemia
No evidence of left atrial hypertension
TRALI
DIAGNOSIS
CXR: bilateral infiltrates
Donor test for HLA/HNA antibodies
Recipient test for
HLA/HNA antigens
TRALI
TREATMENT
Discontinue transfusion
Maintain vascular access
Supplemental oxygen
Mechanical ventilation
TRALI
PREVENTION
Use male only plasma
Exclude or screen female platelet donors
TACO
SYMPTOMS
Severe hypoxemia
⬆️ Blood pressure
Jugular vein distension
⬆️ Central venous pressure
TACO
DIAGNOSIS
CXR: pulmonary edema,
cardiomegaly,
distended pulmonary artery
BNP
TACO
TREATMENT
Upright posture
Supplemental oxygen
Diuresis
TACO
PREVENTION
Slower transfusion rate
Transfuse in smaller volumes
