Therapeutics

Question 1

List blood transfusion complications [7]

Answer 1

Immunological reactions
- Anaphylaxis
- Acute haemolytic reaction
- Non-haemolytic febrile reactions
- Minor allergic reaction
- Transfusion related acute lung injury (TRALI)
- Delayed haemolytic

Infection/ Septic

Transfusion associated circulatory overload (TACO)

Biochemistry abnormalities (i.e. iron overload)

Question 2

Anaphylaxis in blood transfusion reaction
- Mechanism
- Presentation
- Management

Answer 2

Severe hypersensitivity reaction to blood donor proteins
- Can occur in patients with deficiency of IgA who makes anti-IgA antibodies= blood products containing IgA triggers reaction

Presentation
- Angioedema
- Hypotension
- Wheeze
- Urticaria

Management
- Stop transfusion
- IM adrenaline
- A-E management

Question 3

Acute haemolytic in blood transfusion reaction
- Mechanism
- Presentation
- Management

Answer 3

ABO incompatibility due to human error

Presentation
- Fever
- Abdominal pain
- Hypotension

Management
- Stop transfusion
- Repeat typing and crossmatching

Question 4

Minor allergic in blood transfusion reaction
- Mechanism
- Presentation
- Management

Answer 4

Hypersensitivity reaction to foreign plasma proteins

Presentation
- Pruritis
- Urticaria

Management
- Stop infusion
- Antihistamine

Question 5

Non-haemolytic febrile blood transfusion reaction
- Mechanism
- Presentation
- Management

Answer 5

Donor white cell fragments release cytokines
- More common in platelet transfusions

Presentation
- Fever, chills

Management
- Paracetamol
- Slow/ stop infusion

Question 6

Transfusion related acute lung injury (TRALI)
- Mechanism
- Presentation
- Management

Answer 6

Pulmonary oedema due to immunological activation of host antigens to antibodies (HLA or human neutrophil antigen) in donor blood

Presentation
- Dyspnoea
- Hypoxia
- Fever
- Hypotension
- CXR= pulmonary infiltrates

Management
- Stop transfusion
- Oxygen, supportive care

Question 7

Transfusion associated circulatory overload (TACO)
- Mechanism
- Presentation
- Management

Answer 7

Excess transfusion rate leading to volume overload
- Commonly in patients with heart failure

Presentation
- Pulmonary oedema (dyspnoea, hypoxia)
- Peripheral oedema
- Hypertension

Management
- Stop/ slow transfusion
- IV diuretics
- Oxygen

Question 8

Delayed transfusion reaction
- Mechanism

Answer 8

Host reaction to donor’s foreign antigen previous exposed to.