Haematological transfusion reactions Flashcards
What are the 5 transfusion reactions? FeverHALO
Fever: Febrile non-haemolytic transfusion reaction
H: Haemolytic transfusion reaction (acute vs delayed)
A: Anaphylactic transfusion reaction
L: Lung: TRALI
O: Overload: TACO
What is febrile non-haemolytic transfusion reaction?
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
What causes febrile non-haemolytic transfusion reaction?
Cytokines released from residual WBCs or platelet components in the blood unit, which trigger inflammation
What are the 3 common signs and symptoms of febrile non-haemolytic reaction?
Fever & chills
Severe rigors (shivering and coldness, with a fever)
Tachycardia
How is febrile non-haemolytic transfusion reaction managed?
- Temporarily stop the transfusion
- Administer 1 gram paracetamol orally
- Recheck that correct blood is being transfused
- Restart transfusion and monitor more frequently eg. 10-15 minutes
What is anaphylactic transfusion reaction?
Life-threatening, severe allergic reaction that usually occurs within few minutes of starting transfusion
What causes anaphylactic transfusion reaction?
IgA-mediated against plasma products
What are the common signs and symptoms of anaphylactic transfusion reaction?
Respiratory distress: Chest pain, SOB, hypotension, bronchospasms
Urticaria and angioedema, conjunctivitis, erythema around eyes, lip swelling
Abdominal pain and vomiting
How is anaphylactic transfusion reaction managed?
- Stop transfusion and keep line open with saline STAT dose
- Subcut adrenaline
- IV antihistamine eg. chlorphenamine
- Oxygen by mask
What is TRALI?
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
Due to neutrophil activation in lungs which causes capillaries to leak fluid
Associated with plasma products
What are the signs and symptoms of TRALI?
Rapid onset of tachypnea and dyspnea with SpO2 below 90%
Hypotension
Cyanosis, fever, chills
If TRALI is suspected, what radiological investigation should be done to confirm it?
Chest x-ray
Bilateral pulmonary edema with bilateral patchy infiltrates
No cardiomegaly
What can TRALI progress to if severe or not treated?
White out bilaterally on CXR, indistinguishable from acute respiratory distress syndrome (ARDS)
How is TRALI managed?
- Stop transfusion and keep line open with saline STAT dose (IV fluids)
- Supplemental oxygen 15L non-rebreathe mask and mechanical ventilation
- Notify blood bank to screen unit for antileukocyte antibodies, anti-HLA or anti-neutrophil-specific antibodies
What is TACO?
Transfusion-associated Circulatory Overload
Cardiogenic pulmonary edema and respiratory distress due to volume overload during or up to 12 hours after transfusion
Caused by rapid transfusion of large volumes of blood products
What are the signs and symptoms of TACO?
New onset dyspnea
Peripheral edema eg. in ankles
Hypertension
Raised JVP
Basal lung crackles
What does the CXR of TACO look like?
Chest x-ray
Bilateral pulmonary edema with bilateral patchy infiltrates
How is TACO treated?
P: Position upright
O: Oxygen therapy
D: Diuretics eg. furosemide
Which lab test can distinguish TACO from TRALI?
TACO: Raised BNP
TRALI: Decreased neutrophil count, normal BNP
What is DIC?
