Transfusion Reactions

Question 1

Why does a non-haemolytic febrile reaction sometimes occur with blood product transfusions?

Answer 1

antibodies reacting with:
1. white cell fragments in the blood product
2. cytokines that have leaked from the blood cell during storage

Question 2

How often do non-haemolytic febrile transfusion reactions occur?

Answer 2

Red cell transfusion (1-2%)
Platelet transfusion (10-30%)

Question 3

Symptoms in a non-haemolytic febrile transfusion reaction

Answer 3

Fever/chills

Question 4

Management of a non-haemolytic febrile reaction

Answer 4

Slow or stop the transfusion

Paracetamol

Monitor

Question 5

Describe the symptoms of a minor allergic reaction to blood products

Answer 5

Pruritus, urticaria

Question 6

Why do minor allergic reactions occur with blood products?

Answer 6

caused by foreign plasma proteins

Question 7

Management of a minor allergic reaction

Answer 7

Temporarily stop the transfusion

Antihistamine

Monitor

Question 8

What can cause anaphylaxis in response to a blood product?

Answer 8

patients with IgA deficiency who have anti-IgA antibodies

Question 9

Anaphylaxis symptoms

Answer 9

Hypotension
dyspnoea
wheezing
angioedema

Question 10

Management of anaphylaxis to blood product

Answer 10

Stop the transfusion

IM adrenaline

ABC support
oxygen
fluids

Question 11

What causes an acute haemolytic reaction ?

Answer 11

ABO-incompatible blood

=> IgM causes intravscular haemolysis

Question 12

Symptoms of acute haemolytic reaction

Answer 12

Fever
Abdominal pain
Hypotension

Question 13

Management of acute haemolytic reaction

Answer 13

Stop transfusion

Confirm identity of patient against blood

send blood for direct Coombs test, repeat typing and cross-matching

Supportive care
fluid resuscitation

Question 14

Cause of Transfusion Associated Circulatory Overload (TACO)

Answer 14

Excessive rate of transfusion, pre-existing heart failure

Question 15

Symptoms/Signs of TACO

Answer 15

Pulmonary oedema, hypertension

Question 16

Management of TACO

Answer 16

Slow or stop transfusion

O2 if required

Consider IV furosemide

Question 17

What can cause transfusion associated lung injury (TRALI)?

Answer 17

Non-cardiogenic pulmonary oedema

secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood

Question 18

Symptoms of TRALI

Answer 18

Hypoxia
Pulmonary infiltrates on CXR
Fever
Hypotension

Question 19

Management of TRALI

Answer 19

Stop the transfusion

Oxygen and supportive care