Blood transfusion complications

Question 1

What are the mediators, s/sx and treatment of hemolytic transfusion reactions?

Answer 1

Mediators: IgM A/B (usually ABO)
S/sx: Fever, chills, hemoglobinemia, hemoglobinuria, hypotension, dyspnea
T: decrease opportunities for errors, treat ARF and DIC

Question 2

What are the mediators, s/sx and treatment of nonhemolytic febrile transfusion reactions?

Answer 2

M: A/b to HLA class 1 Ag
S/sx: fever, chills
T: antipyretics and use leukocyte reduced products

Question 3

What are the mediators, s/sx and treatment of allergic transfusion reactions?

Answer 3

M: Plasma proteins, A/b to IgA
S/sx: urticaria, erythema, itching, anaphylaxis
T: antihistamines, treat symptoms, transfuse IgA-deficient components

Question 4

What are the mediators, s/sx and treatment of noncardiogenic pulmonary transfusion reactions?

Answer 4

M: donor/recipient WBC A/b
S/sx: ARDs, fever, chills, cyanosis, hypotension, noncardiogenic pulmonary edema
T: vigorous respiratory support (PEEP to push fluid back out), steroids

Question 5

What are the mediators, s/sx and treatment of bacterial contamination transfusion reaction?

Answer 5

M: endotoxins from bacteria
S/sx: fever, shock, hemoglobinuria
T: IV abx, treat hypotension and DIC

Question 6

What are the mediators, s/sx and treatment of TACO?

Answer 6

M: fluid volume
S/sx: coughing, cyanosis, orthopnea, severe HA, peripheral edema, difficulty breathing
T: administer subsequent transfusions slowly and in as small a volume as possible

Question 7

What are the mediators, s/sx and treatment of hemolysis d/t physical/chemical means?

Answer 7

M: exogenous destruction of RBCs
S/sx: hemoglobinuria
T: document and rule out hemolysis d/t other causes, treat DIC

Question 8

What are the mediators, s/sx and treatment of a delayed hemolytic transfusion reaction?

Answer 8

M: IgG A/b
S/sx: shortened RBC survival, decreased Hgb, fever, jaundice, hemoglobinuria
T: Ig-negative blood for further infusions

Question 9

What are the mediators, s/sx and treatment of graft-versus host disease

Answer 9

M: Donor lymphocytes
S/sx: fever, skin rash, desquamation, anorexia, N/V, diarrhea, hepatitis, pancytopenia (low platelets and WBCs)
T: gamma irradiation of cellular components

Question 10

What are the mediators, s/sx and treatment of post-transfusion purpura?

Answer 10

M: platelet specific A/b
S/sx: thrombocytopenia, bleeding
T: IV Ig, plasma exchange, corticosteroids