Non-Haemolytic Transfusion Reactions

Question 1

Infective Shock

Answer 1

• Bacterial contamination of blood is rare but can be fatal
• Acute onset of hypotension, rigors and collapse
• Platelets more likely to be associated (G+)

Question 2

TRALI

Answer 2

• Acute respiratory distress due to donor plasma containing antibodies against patients leukocytes
• Development within 6 hours of prominent non-productive cough, breathlessness, hypoxia and frothy sputum.
• Fever and rigors may also be present
• CXR shows perihilar nodules with infiltration of lower lung fields
• Implicated donors usually multiparous women

Question 3

Fluid Overload

Answer 3

• Particular risk in those with chronic anaemia who are normovolaemic or hypervolaemic and those with symptoms of cardiac failure prior to transfusion
• Should receive packed cells via slow transfusion with diuretics if required

Question 4

Non-haemolytic febrile reactions

Answer 4

• Fevers and rigors may develop towards end of transfusion
• Multiparous women and those who have had previous transfusions most at risk
• Due to patient antibodies to transfused white cells
• Reactions are unpleasant but not life threatening
• Slow transfusion, paracetamol

Question 5

Anaphylaxis

Answer 5

• Previously sensitised
• Acute dyspnoea, chest pain, abdo pain, nausea
• Urticaria and itching within minutes
• Slow transfusion and give antihistamines, if no progression after 30min, continue
• Can pre-treat with chlorphenamine if PHx

Question 6

Non-Haemolytic Transfusion Reactions Presentation

Answer 6

• Can occur after 5-10mls
• Feeling of apprehension
• Flushing
• Chills
• Pain at site
• Myalgia
• Nausea
• Fever, change in BP, tachycardia, respiratory distress

Question 7

Non-Haemolytic Acute Transfusion Reactions Ix

Answer 7

• As per S/Ss
• Do not delay treatment
• Measure IgA for those with moderate/severe allergic reactions
• Post transfusion bloods to detect haemolytic reaction (direct Coombs’, repeat type and crossmatch, antibody screen, clotting, FBC)
• Urine specimen for urinary haemoglobinuria
• Seek advice for anaphylactic
• If bacterial contamination suspected send blood culture from patient and bag
• Anti-leukocyte antibody Ixs in TRALI

Question 8

Non-Haemolytic Transfusion Reactions Management

Answer 8

• Ask patient to report symptoms that develop
• If hypotensive, think about wether from haemorrhage or transfusion
• If mild fever or mild urticaria, recheck blood, give paracetamol and antihistamine, slow transfusion and observe
• If severe reaction stop transfusion, adrenalin, repeat every 10mins
• If ABO incompatibility; keep IV line open with saline, A-E
• If TRALI; seek expert help, oxygen, fluids
• If fluid overload give furosemide IV and high-concentration oxygen