Transfusion reactions Flashcards
What reaction has a rapid onset fever/chills/rigor, discomfort at site of infusion, dyspnea, tachycardia, backache/headache, hemoglobinemia/hemoglobinuria, DIC, hypotension, renal failure, death?
acute hemolytic transfusion reaction
When is the most severe acute hemolytic reaction?
intraoperative, from ABO isoagglutinin or alloantibodies (mislabelling, giving to wrong patient)
How do you manage acute hemolytic transfusion reaction?
DIC w/ coag studies, vitals, stop transfusion immediately!!
IV fluids + mannitol to prevent acute kidney injury
What reaction is 3-10 days after transfusion and possibly asymptomatic?
delayed hemolytic transfusion reaction
In who is delayed hemolytic transfusion reaction common?
patients previously sensitized but low antibody levels and alloantibody screening
How can you diagnose delayed hemolytic transfusion reaction?
drop in hemoglobin and in crease in total and indirect bilirubin
newly + serum alloantibody test
How do you treat delayed hemolytic transfusion reaction?
none required but additional blood transfusions may be needed, check for AKI or DIC
What type of reaction is chills and rigor w/n 12 hours of transfusion (1 degree C rise in temp) with severe having cough, dyspnea?
febrile non-hemolytic transfusion reaction “leukoagglutinin reaction”
In who is febrile non-hemolytic transfusion reaction common?
patients w/ prior exposure (transfusions or pregnancy)
In what is febrile non-hemolytic transfusion reaction caused by?
leukocyte rich products and mediated by antibodies against donor
How do you diagnose febrile non-hemolytic transfusion reaction ?
Rule out other causes of fever – Hgb increases, no hemolysis
How do you manage febrile non-hemolytic transfusion reaction ?
change to reduced leukocyte blood products (make reactions less severe)
pretreat w/ acetaminophen
acetaminophen and Benadryl (diphenhydramine) and consider IV corticosteroids
What reaction has hives, bronchospasms, mild (allergic) or starting immediately with dyspnea, coughing, n/v, hypotension, bronchospasm, LOC, respiratory arrest, shock (anaphylactic)?
allergic reaction to blood transfusion
Who is at risk for allergic reaction to blood transfusion?
igA-deficient patients
What is allergic reaction to blood transfusion?
reaction to plasma proteins
How ca n you prevent allergic reaction to blood transfusion?
washed to remove plasma for history, and pre-treatment
How do you treat allergic allergic reaction to blood transfusion
stop transfusion temporarily and administer diphenhydramine
How do you treat anaphylactic allergic reaction to blood transfusion?
stop transfusion immediately and administer epinephrine, maybe glucocorticoids
How do you treat IgA deficient allergic reaction to blood transfusion
IgA deficient plasma and washed cellular components
What is usually fatal and symptoms occur 8-12 days post transfusion, then fever, rash, diarrhea, hepatitis, lymphadenopathy, marrow aplasia, severe pancytopenia?
graft vs host disease
How can you treat graft vs host disease?
can’t really treat, but you can prevent – irradiation of cellular components before transfusion in at risk patients — fetuses, lymphoma patients, immunosuppressed, recipients from blood relative, recipients w/ marrow transplantation – all need to be washed
What is sudden acute respiratory distress following transfusion?
TRALI - transfusion-related acute lung injury, mainly in surgical and critically ill patients
What causes acute respiratory distress following transfusion?
non-cardiogenic pulmonary edema w/n 6 hours after blood product transfusion without other explanation (antibodies bind to recipient’s leuokocyte antigens)
How can you prevent TRALI?
male-only plasma donors (women have more anti-leukocyte Ab)
