Transfusion Reaction

Question 1

What is a transfusion reaction?

Answer 1

Adverse reaction to transfused blood or blood components, ranging from mild to life-threatening.

Question 2

What are the clinical features of a transfusion reaction?

Answer 2

1. Fever
2. Allergy/Anaphylaxis type reactions
3. Inflammation (rigors, hypotension, shock)
4. Respiratory (none, dyspnea, ARDS, hypoxemia)

Question 3

What are immunologically-mediated types of transfusion reaction?

Answer 3

Hemolytic
Febrile non-hemolytic
Urticarial
Anaphylactic
TRALI (hypoxemia, bilat infiltrates on CXR)
GVHD (fever, rash, diarrhea, hepatitis)

Question 4

What are nonimmunologic types of transfusion reactions and transfusion-associated complications?

Answer 4

1. TACO - transfusion-associated circulatory overload (dypsnea, tachycardia, hypertension, increased PAWP)
Nonimmune hemolysis
Sepsis
hypocalcemia
hypothermia
hyperkalemia
air embolus

Question 5

What is the management of an acute hemolytic transfusion reaction?

Answer 5

1. Stop transfusion
2. Determine diagnosis
3. Maintain hemodynamics
4. Maintain UOP (fluid, mannitol, diuretics, alkalinization)
5. Monitor for hyperkalemia
6. blood for CBC, coagulation, fibrinogen, haptoglobin
7. send blood back to blood bank for re-cross match

Question 6

What is the management of a febrile non-hemolytic transfusion reaction?

Answer 6

1. Stop transfusion
2. Determine diagnosis
3. Stop and determine if acute hemolytic reaction
4. Treat fever with acetaminophen
5. Leukoreduction of blood products can reduce incidence

Question 7

What preparatory technique can reduce the incidence of febrile non-hemolytic transfusion reactions?

Answer 7

Leukoreduction

Question 8

What is the management of an urticarial transfusion reaction?

Answer 8

1. Can continue transfusion
2. Antihistamines - diphenhydramine (pretreatment with steroids ineffective)
3. Washing PRBCs in saline will reduce allergic reactions

Question 9

What can be done prior transfusion to reduce the incidence or severity of urticarial transfusion reactions?

Answer 9

1. Washing pRBCs in saline will reduce

2. Pretreatment with steroids is ineffective

Question 10

What is the management of an anaphylactic transfusion reaction?

Answer 10

1. Stop transfusion
2. Determine diagnosis
3. IV fluids
4. Epinephrine bolus/infusion as required
5. Monitor peak airway pressures
6. Antihistamines and corticosteroids

Question 11

What is the management of TRALI?

Answer 11

1. Stop transfusion
2. Determine diagnosis
3. Give supplemental O2
4. Intubate/ventilate

Question 12

What is the management of a GVHD transfusion reaction?

Answer 12

1. Stop transfusion
2. Determine diagnosis
3. No effective treatment
4. Prevention w/ irradiated blood products

Question 13

What can be done to prevent GVHD from transfused blood products?

Answer 13

Irradiation prior to administration

Question 14

What is the management of TACO?

Answer 14

1. Supplemental O2
2. Diuretics
3. Prevention: volume reduction of pRBCs

Question 15

How might TACO be prevented?

Answer 15

Volume reduction of pRBCs