transfusion reactions Flashcards
what are the types of transfusion complications?
immunological: acute haemolytic, non-haemolytic febrile, allergic/anaphylaxis
infective
transfusion-related acute lung injury (TRALI)
transfusion-associated circulatory overload (TACO)
other: hyperkalaemia, iron overload, clotting
what is non-haemolytic febrile reaction?
Thought to be caused by antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage
features of non-haemolytic febrile reaction?
Fever, chills
causes of non-haemolytic febrile reaction?
Red cell transfusion (1-2%)
Platelet transfusion (10-30%)
mx of non-haemolytic febrile reaction?
Slow or stop the transfusion
Paracetamol
Monitor
what is a minor allergic reaction?
Thought to be caused by foreign plasma proteins
features of minor allergic reaction?
Pruritus, urticaria
mx of minor allergic reaction?
Temporarily stop the transfusion
Antihistamine
Monitor
what is anaphylaxis?
Can be caused by patients with IgA deficiency who have anti-IgA antibodies
features of anaphylaxis?
Hypotension, dyspnoea, wheezing, angioedema.
mx of anaphylaxis?
Stop the transfusion
IM adrenaline
ABC support
oxygen
fluids
what is acute haemolytic reaction?
ABO-incompatible blood e.g. secondary to human error
features of acute haemolytic reaction?
Fever, abdominal pain, hypotension
mx of acute haemolytic reaction?
Stop transfusion
Confirm diagnosis
check the identity of patient/name on blood product
send blood for direct Coombs test, repeat typing and cross-matching
Supportive care
fluid resuscitation
what is Transfusion-associated circulatory overload (TACO)?
Excessive rate of transfusion, pre-existing heart failure
features of TACO?
Pulmonary oedema, hypertension
mx of TACO?
Slow or stop transfusion
Consider intravenous loop diuretic (e.g. furosemide) and oxygen
what is Transfusion-related acute lung injury (TRALI)?
Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood
features of TRALI?
Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension
mx of TRALI?
Stop the transfusion
Oxygen and supportive care
which antibodies are involved in an acute haemolytic reaction?
IgM - causes RBC destruction
complications of acute haemolytic reaction?
DIC, renal failure
what antibodies are involved in non-haemolytic febrile reaction?
WBC HLA antibodies
often the result of sensitization by previous pregnancies or transfusions
what can you give in non-haemolytic febrile reaction?
paracetamol
how do you characterise TRALI?
Characterised by the development of hypoxaemia / acute respiratory distress syndrome within 6 hours of transfusion.
how do you differentiate TACO and TRALI?
A relatively common reaction due to fluid overload resulting in pulmonary oedema (TACO). As well as features of pulmonary oedema the patient may also by hypertensive, a key difference from patients with TRALI.
what can infect platelet product? what’s done to mitigate this?
Platelets are stored at room temperature, which increases the risk of bacterial proliferation. Common contaminants include Staphylococcus epidermidis and Bacillus cereus.
what is the risk of infection with platelet transfusion?
Bacterial contamination of platelets is more likely to lead to rapid onset of sepsis and septic shock, given the optimal growth conditions during storage.
