Transfusion reactions Flashcards
What defines acute reactions to transfusion and what are the types
<24hrs
Transfusion associated circulatory overload (TACO) - most common
Acute haemolytic (ABO incompatible)
Allergic/anaphylaxis
Infection (bacterial)
Febrile non-haemolytic
Acute lung injury (TRALI)
What defines delayed reactions to transfusion and what are the types
> 24 hours
Delayed haemolytic transfusion reaction (antibodies) – Duffy and Kidd
Infection (viral, malaria, vCJD)
TA-GvHD (week or 2 after transfusion)
Post transfusion purpura
Iron overload
What are the early signs of an acute reaction and how may you pick these signs up in a patient who is unconscious
- Raised temperature and pulse, reduce BP
- General symptoms: fever, rigors, flushing, N&V, dyspnoea, chest pain, urticaria, itching, headache, collapse
Continuous monitoring
Before transfusion: baseline temp, RR, BP, pulse
Repeat post-transfusion: 15 mins and every hour
Describe Febrile Non-Haemolytic Transfusion Reaction (FNHTR) and its treatment
Occurs during/soon after transfusion (blood or platelets)
(Now rare due to leucodepletion of blood)
Rise in temperature by around 1 degree, chills and rigors
Caused by the release of cytokines from white cells during storage
Tx: transfusion stopped or slowed and may need to be treated with paracetamol
Describe allergic transfusion reactions and its treatment
Common, especially with plasma (proteins in plasma)
Causes a mild urticarial or itchy rash sometimes with a wheeze – caused by allergy to donor plasma proteins
Can occur during or after (even after patient has left) transfusion transfusion usually stopped or slowed
Recipients have a history of atopy
Tx: IV antihistamines
Describe ABO incompatibility reactions and what investigations should be done if suspected
Symptoms and signs of acute intravascular haemolysis (IgM-mediated): restless, chest/loin pain, fever, vomiting, flushing, collapse, haemoglobinuria (later)
Causes: failure of bedside check, wrongly labelled sample, lab error
Ix: FBC, Biochem, Coagulation, repeat X-match, DAT
Describe bacterial contamination reactions in transfusion
Presents similarly to ABO mismatch
Bacterial growth can cause endotoxin production which causes immediate collapse
May be: from the donor (GI, dental, skin infection) OR introduced during processing (environmental or skin)
Platelets (stored at room temperature) > RBCs > FFP
Describe anaphylaxis during transfusion
Severe, life-threatening reaction soon after the start of transfusion → hypotension + tachy ± laryngeal/facial oedema, wheeze, SOB
Mechanism: IgE antibodiesin the patient cause mast cell degranulation
Increased severity of allergic reaction due to IgA deficiency
Describe Transfusion Associated Circulatory Overload (TACO), its signs and symptoms and what investigations should be done
Most common acute transfusion reaction
Pulmonary oedema/fluid overload
Caused by lack of monitoring of fluid balance, especially in HF, renal impairment, hypoalbuminaemia
S/S: SOB, low sats (fluid overload), tachy and HTN (HF)
CXR: fluid overload
Describe Transfusion Related Acute Lung Injury (TRALI)
Similar presentation to ARDS, NO fluid overload (unlike TACO)
More common in FFP or platelet transfusion
Anti-WBC Abs in the donor blood → react with pt WBCs → aggregates stick to pulmonary capillaries → neutrophil proteolytic enzymes + toxic O2 metabolites
Features: FEVER, SOB, low sats, high HR, high BP
CXR: bilateral pulmonary infiltrates during/within 6 hours of transfusion due to circulatory overload and other causes
What is the difference in treatment response between TACO and TRALI
TACO responds to diuretics immediately (and has raised JVP)
TRALI does NOT respond to diuretics (no JVP)
Describe Delayed Haemolytic Transfusion Reaction and what investigations should be done
Usually to Duffy and Kidd antigens
Patients develop ABs against the RBC antigen they lack (alloimmunisation) → any further transfusions with those RBCs → extravascular haemolysis
IgG mediated, takes 5-10 days
Ix: bilirubin, FBC, LDH, reticulocytes, urine dip, DAT, U&Es
Describe infection during transfusion as a delayed reaction
Anti-A, Anti-B = IgM antibodies | Anti-Rh, anti-Duffy, anti-Kidd = IgG antibodies
Examples = malaria, viral infections (CMV, parvovirus), variant CJD (“Mad Cow Disease)
Symptoms may occur months or years after the transfusion
Describe Transfusion Associated Graft-Versus-Host Disease (TaGVHD)
Rare but ALWAYS FATAL
Can take weeks to months to come on after transfusion
Susceptible patient (immunosuppressed) do not destroy the donor lymphocytes → donor recognises patient HLA as foreign → attacks all HLA antigens (gut, liver, skin, bone marrow)
S/S: diarrhoea, liver failure, skin desquamation, bone marrow failure, death
How is Transfusion Associated Graft-Versus-Host Disease (TaGVHD) prevented
irradiate blood components for very immunocompromised patients or have HLA-matched components
