Chapter 62 - prevention & treatment of transfusion reactions

Question 1

Reported incidence of overt transfusion reactions in dogs?

Answer 1

3-13%

Question 2

Why may some be overlooked

Answer 2

clinical signs of reaction (fever, weakness, lethargy, tachycardia, tachypnea) attributed to underlying disease

Question 3

Most common type of reaction reported in humans and veterinary patients?

Answer 3

febrile non-hemolytic (FNHTR)

Question 4

Effects of residual WBCs in transfusions + 3 clinical syndromes

Answer 4

‘Cytokine soup’ - leucocytes undergo lysis, release immunomodulators such as histamine, myeloperoxidase, plasminogen activator inhibitor I, eosinophilic cationic protein - immunosuppression, thrombocytopenia, TRALI, SIRS

Question 5

Mortality rates of dogs receiving transfusion (note most deaths assumed due to underlying disease!)

Answer 5

39-53%

Question 6

academic categories of reactions?

Answer 6

immunologic, nonimmunologic

Question 7

clinical categories?

Answer 7

mild, mod, severe

Question 8

What are the clinical signs of a mild reaction? Suggested treatment?

Answer 8

mild fever, urticaria, facial edema
Stop transfusion, can restart at a slower rate in 15-30mins if resolving, consider diphenhydramine 1-4mg/kg SC/IM/IV if cutaneous signs suggestive of hypersensitivity reaction

Question 9

What are the clinical signs of a mod reaction? Suggested treatment?

Answer 9

fever, tachycardia, tachypnea, weakness, vomiting
Stop transfusion, crystalloid fluid boluses PRN
No evidence for diphenhydramine & glucocorticoids

Question 10

What are the clinical signs of a severe reaction? Suggested treatment?

Answer 10

Collapse, tachycardia/bradycardia, tachypnea, hypotension, fever, hypothermia. Dogs: Secure airway if needed, ventilate PRN. Epinephrine 0.01mg/kg + half shock bolus of isotonic crystalloids +/- colloids.