Transfusion reactions Flashcards
What causes a non-haemolytic febrile transfusion reaction?
alloimmunised recipient produces cytokines due to donor leukocytes/HLA antigens
Clinical features of a non-haemolytic febrile transfusion reaction
shivering, fever, +/- headache
nausea
flushing
tachycardia
usually 30-60 mins after starting transfusion
(patient hot but well, most common reaction)
Management of non-haemolytic febrile transfusion reaction
slow transfusion
monitor frequently
paracetamol
What antibody mediated an acute haemolytic reaction/ABO incompatibility?
IgM
Clinical features of an acute haemolytic reaction/ABO incompatibility
fever
hypotension
agitation
flushing
abdominal/chest pain
bleeding/DIC/AKI
patient is very unwell
occurs within minutes of starting transfusion
Acute haemolytic reaction/ABO incompatibility management
stop transfusion
supportive management
ABCDE
Bacterial contamination clinical features
fever
hypotension
rigors (–> septic shock)
Bacterial contamination management
stop transfusion
treat as sepsis (broad spectrum antibiotics)
Delayed haemolytic reaction clinical features
anaemia
jaundice
haemoglobinuria
usually 4-8 days (can be up to 4 weeks) after transfusion
Delayed haemolytic reaction management
investigations
monitor renal function
specific treatment rarely required
Clinical features of transfusion-related acute lung injury (TRALI)
acute respiratory distress syndrome
dyspnoea
cough
CXR whiteout
usually <6 (around 2) hours after transfusion
Clinical features of fluid overload (TACO - transfusion-associated circulatory overload)
dyspnoea
hypoxia
tachycardia
increased JVP (jugular venous pulse)
basal crepitations
TRALI management
stop transfusion if ongoing
supportive care
ABCDE
oxygen
ICU
Fluid overload management
stop transfusion
treat as acute LVF (left ventricular failure):
- furosemide
- oxygen
What can help distinguish between TRALI and fluid overload/TACO?
TRALI more likely if severe or no history of LVF
overload more likely if LVF history present
Which antibody mediated anaphylaxis?
IgA
Clinical features of anaphylaxis
bronchospasm
cyanosis
hypotension
soft tissue swelling
Anaphylaxis management
stop transfusion
treat as anaphylaxis:
- IM adrenaline
- maintain airway
- call anaesthetist
What causes allergic reactions in blood transfusions?
plasma protein incompatibility
Clinical features of allergic reactions
urticaria
itch
Management of allergic reactions
stop or slow transfusion depending on severity
chlorpheniramine (anti-histamine)
What causes transfusion-associated graft-versus-host disease?
lymphocyte contamination of transfusion product
immune response against recipient cells
Symptoms of transfusion-associated graft-versus-host disease
rash
pyrexia
diarrhoea
deranged LFTs
bone marrow aplasia
How can transfusion reactions be prevented?
cross-matching and serologic cross-matching
infection screening questionnaire
infection screening tests on all collected samples
grouping - ABO + Rh status
antibody screening
cytomegalovirus negativity
irradiated red cells
consider alternatives to transfusion
