Haematological transfusion reactions

Question 1

What are the 5 transfusion reactions? FeverHALO

Answer 1

Fever: Febrile non-haemolytic transfusion reaction

H: Haemolytic transfusion reaction (acute vs delayed)

A: Anaphylactic transfusion reaction

L: Lung: TRALI

O: Overload: TACO

Question 2

What is febrile non-haemolytic transfusion reaction?

Answer 2

Unexpected temperature rise (≥38°C or ≥1°C above baseline, if baseline ≥37°C) that occurs during transfusion or within 4 hours after stopping transfusion

Question 3

What causes febrile non-haemolytic transfusion reaction?

Answer 3

Cytokines released from residual WBCs or platelet components in the blood unit, which trigger inflammation

Question 4

What are the 3 common signs and symptoms of febrile non-haemolytic reaction?

Answer 4

Fever & chills

Severe rigors (shivering and coldness, with a fever)

Tachycardia

Question 5

How is febrile non-haemolytic transfusion reaction managed?

Answer 5

1. Temporarily stop the transfusion
2. Administer 1 gram paracetamol orally
3. Recheck that correct blood is being transfused
4. Restart transfusion and monitor more frequently eg. 10-15 minutes

Question 6

What is anaphylactic transfusion reaction?

Answer 6

Life-threatening, severe allergic reaction that usually occurs within few minutes of starting transfusion

Question 7

What causes anaphylactic transfusion reaction?

Answer 7

IgA-mediated against plasma products

Question 8

What are the common signs and symptoms of anaphylactic transfusion reaction?

Answer 8

Respiratory distress: Chest pain, SOB, hypotension, bronchospasms

Urticaria and angioedema, conjunctivitis, erythema around eyes, lip swelling

Abdominal pain and vomiting

Question 9

How is anaphylactic transfusion reaction managed?

Answer 9

1. Stop transfusion and keep line open with saline STAT dose
2. Subcut adrenaline
3. IV antihistamine eg. chlorphenamine
4. Oxygen by mask

Question 10

What is TRALI?

Answer 10

Transfusion-Related Acute Lung Injury

New acute lung injury and non-cardiogenic pulmonary edema associated with hypoxia during transfusion or within 6 hours after finishing transfusion

Question 11

What are the signs and symptoms of TRALI?

Answer 11

Rapid onset of tachypnea and dyspnea with SpO2 below 90%

Hypotension

Cyanosis, fever, chills

Question 12

If TRALI is suspected, what radiological investigation should be done to confirm it?

Answer 12

Chest x-ray

Bilateral pulmonary edema with bilateral patchy infiltrates

No cardiomegaly

Question 13

What can TRALI progress to if severe or not treated?

Answer 13

White out bilaterally on CXR, indistinguishable from acute respiratory distress syndrome (ARDS)

Question 14

How is TRALI managed?

Answer 14

1. Stop transfusion and keep line open with saline STAT dose
2. Supplemental oxygen 15L non-rebreathe mask and mechanical ventilation
3. Notify blood bank to screen unit for antileukocyte antibodies, anti-HLA or anti-neutrophil-specific antibodies

Question 15

What is TACO?

Answer 15

Transfusion-associated Circulatory Overload

Cardiogenic pulmonary edema and respiratory distress due to volume overload during or up to 12 hours after transfusion

Question 16

What are the signs and symptoms of TACO?

Answer 16

New onset dyspnea

Peripheral edema eg. in ankles

Hypertension

Raised JVP

Basal lung crackles

Question 17

What does the CXR of TACO look like?

Answer 17

Chest x-ray

Bilateral pulmonary edema with bilateral patchy infiltrates

Question 18

How is TACO treated?