Blood transfusion complications

Question 1

What are the different complications that can result from a transfusion?

Answer 1

Non-haemolytic febrile reaction
Minor allergic reaction
Anaphylaxis
Acute haemolytic reaction
Transfusion-associated circulatory overload (TACO)
Transfusion-related acute lung injury (TRALI)

Question 2

What is a non-haemolytic febrile reaction due to?

Answer 2

Antibodies reacting with white cell fragments in the blood product

Question 3

How could a non-haemolytic febrile reaction present?

Answer 3

Fever
Chills

Question 4

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

Answer 4

Slow/stop transfusion
Paracetamol
Monitor

Question 5

What is an acute haemolytic transfusion reaction due to?

Answer 5

Mismatch of blood group (ABO)

Question 6

What does a mismatch of ABO blood group result in?

Answer 6

Massive intravascular haemolysis

Question 7

How can an acute haemolytic transfusion reaction present?

Answer 7

• Fever
• Abdominal and chest pain
• Agitation
• Hypotension

Question 8

What is an acute haemolytic transfusion reaction due to?

Answer 8

Human error

Question 9

When do symptoms of an acute haemolytic transfusion reaction occur?

Answer 9

Minutes after the transfusion is started

Question 10

What is the massive intravascular haemolysis in an acute haemolytic transfusion reaction due to?

Answer 10

Red blood cell destruction by IgM-type antibodies.

Question 11

What are the possible complications of an acute haemolytic transfusion reaction?

Answer 11

• Disseminated intravascular coagulation
• Renal failure

Question 12

How can an acute haemolytic transfusion reaction beb managed?

Answer 12

• Immediate transfusion termination
• Generous fluid resuscitation with saline solution
• Informing the lab

Question 13

What type of complication is a Transfusion-related acute lung injury (TRALI)?

Answer 13

A rare but potentially fatal complication of blood transfusion

Question 14

What are the main features of a Transfusion-related acute lung injury (TRALI)?

Answer 14

• hypoxia
• pulmonary infiltrates on chest x-ray
• fever
• hypotension

Question 15

What is a Transfusion-related acute lung injury (TRALI) characterised by?

Answer 15

The development of hypoxaemia / acute respiratory distress syndrome within 6 hours of transfusion

Question 16

When does Transfusion-related acute lung injury (TRALI) occur?

Answer 16

Within 6 hours of transfusion

Question 17

What is the management of a Transfusion-related acute lung injury (TRALI)?

Answer 17

Stop the transfusion
Oxygen and supportive care

Question 18

What is Transfusion-associated circulatory overload (TACO) due to?

Answer 18

Excessive rate of transfusion

Or pre-existing heart failurue

Question 19

What can an excessive rate of transfusion result in?

Answer 19

Fluid overload and pulmonary oedema

Question 20

How can Transfusion-associated circulatory overload (TACO) present?

Answer 20

Pulmonary oedema
Hypertension

Question 21

What is the management of Transfusion associated circulatory overload (TACO)?

Answer 21

Slow or stop transfusion
Consider intravenous loop diuretic (e.g. furosemide) and oxygen

Question 22

What is an allergic/anaphylaxis reaction due to?

Answer 22

Hypersensitivity reactions to components within the transfusion.

Question 23

When does an allergic/anaphylaxis reaction usually occur?

Answer 23

Within minutes of starting the transfusion

Question 24

How can a minor allergic reaction present?

Answer 24

Pruritus
Urticaria

Question 25

How can an anaphylaxis reaction present?

Answer 25

Hypotension
Dyspnoea
Wheezing
Angioedema.

Question 26

What is the management of a minor allergic reaction?

Answer 26

Temporarily stop transfusion
Antihistamine
Monitor

Question 27

What is the management of an anaphylaxis reaction?

Answer 27

Stop the transfusion
IM adrenaline
ABC support- oxygen and fluids