Transfusion medicine

Question 1

What are the immune mediated blood transfusion reactions

Answer 1

• Febrile non-haemoltyic transfusion reaction
• Anaphylaxis and mild allergy
• Haemolytic tranfusion reaction
• Transfusion related acute lung injury
• Post-transfusion purpura
• Transfusion related immunomodulation (TRIM)

Question 2

What are the non-immune mediated blood transfusion reactions

Answer 2

• Tranfusion associated circulatory overload
• Transfusion associated sepsis
• Transfusion associated hypotension
• Transfusion associated viral infection

Question 3

What are the first steps in management of a suspected transfusion reaction?

Answer 3

1- stop the infusion
2- Maintain patent IV access (ie saline infusion) and gain 2nd large bore IV access
3- Send of new bloods (G+H, haemolytic screen, coags)
4- Confirm the right blood product for the right patient (ie risk of acute ABO incompatability)
5- Respiratory support
6- Optimize haemodynamics ie fluids, vasopressors, antis ie Tazocin
7- Send off remaining transfusion blood to blood bank for culture

Question 4

What are the causes of acute CVS collapse during a transfusion?

Answer 4

Anaphlyaxis

Acute haemolytic reaction
- Fevers, hypotension, DIC, back pain

TRALI
- Fever, hypotension, crepitations, respiratory distress

TACO
- Distended neck veins, hypertension, resp distress, pink frothy sputum

Others
- Sepsis, pre-existing disease states