Transfusion Reaction Flashcards
What are the features of anaphylactic transform
Type 1 hypersensitivity - pre-formed IgE
transfusion reaction in seconds to minutes or 2-3 hours.
Commonly occurs in individuals with selective IgA deficiency!
Acute angioedema, dyspnoea, urticaria, pruritus and wheezing in the history.
Managed with intramuscular adrenaline
What is an acute haemolytic transfusion reaction?
Type II hypersensitivity occurs due to ABO incompatibility resulting in IgM mediated intravascular haemolysis. Patients present with features of shock, abdominal and chest pain and feeling generally unwell within minutes of the transfusion starting.
There will be jaundice, haemoglobinuria. Flank pain will indicate AKI
What is the management of acute hameolytic transfson reaction?
IV saline for fluid resuscitation
Sample of patient’s blood for direct Coomb;s test
When is IV furosemide given for a transfusion reaction?
Transfusions-associated circulatory overload, typical in patients with pre-existing heart failure
When is IV paracetomol given in transfusion reaction?
Non-haemolytic febrile reaction where patient has fever or chills but is otherwise systemically weell
What is the management for anaphylactic blood transfusion reaction?
Stop transfusion, IM adrenaline, ABC support (O2, fluids)
Patients withselective IgA deficiencyshould receive washed blood products to preventanaphylaxis
What is delayed haemolytic transfusion reaction?
Antibodies against minor antigens e.g. Rhesus (Rh) if Rh -ve and recipient MUST be PREVIOUSLY exposed to the Rh e.g. pregnancy or prior transfusion
Antibodies mark them for destruction via spleen & liver → extravascular haemolysis.
- Asymptomatic or
- Mild fever
- Jaundice
Self-limiting.
What is febrile non-haemolytic transfusion reaction?
Most common transfusion reaction.
Release of cytokines from old or lysed donor WBC, which provoke an inflammatory reaction
1-6 hours after transfusion
-Fever following transfusion
- Chills
Headache
- Flushing
-ve Coombs test.
What is the management of febrile transfusion reaction?
Slow/stop transfusion, paracetamol, monitor
More common in children and can be Prevented by leukoreduction (WBC removed from blood prior to transfusion)
Slow/stop transfusion, paracetamol, monitor
What is the most common cause of death in transfusion reaction?
Transfusions related acute lung injury caused by 2 hit models.
—> 1st any stressor causes neutrophils in pulmonary capillaries - prime neutrophils → 2nd stressor, antibodies in donor blood active primed neutrophils. Fluid accumulation.
How does TRALI present?
Non-cardiogenic pulmonary oedema
- Dyspnoea
- Tachypnoea
-Fever
• Hypotension
How is TRALI managed?
Stop transfusion, fluid resuscitation, vasopressors, aggressive respiratory support
