transfusion reactions

Question 1

what are the types of transfusion complications?

Answer 1

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

Question 2

what is non-haemolytic febrile reaction?

Answer 2

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

Question 3

features of non-haemolytic febrile reaction?

Answer 3

Fever, chills

Question 4

causes of non-haemolytic febrile reaction?

Answer 4

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

Question 5

mx of non-haemolytic febrile reaction?

Answer 5

Slow or stop the transfusion

Paracetamol

Monitor

Question 6

what is a minor allergic reaction?

Answer 6

Thought to be caused by foreign plasma proteins

Question 7

features of minor allergic reaction?

Answer 7

Pruritus, urticaria

Question 8

mx of minor allergic reaction?

Answer 8

Temporarily stop the transfusion

Antihistamine

Monitor

Question 9

what is anaphylaxis?

Answer 9

Can be caused by patients with IgA deficiency who have anti-IgA antibodies

Question 10

features of anaphylaxis?

Answer 10

Hypotension, dyspnoea, wheezing, angioedema.

Question 11

mx of anaphylaxis?

Answer 11

Stop the transfusion

IM adrenaline

ABC support
oxygen
fluids

Question 12

what is acute haemolytic reaction?

Answer 12

ABO-incompatible blood e.g. secondary to human error

Question 13

features of acute haemolytic reaction?

Answer 13

Fever, abdominal pain, hypotension

Question 14

mx of acute haemolytic reaction?

Answer 14

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

Question 15

what is Transfusion-associated circulatory overload (TACO)?

Answer 15

Excessive rate of transfusion, pre-existing heart failure

Question 16

features of TACO?

Answer 16

Pulmonary oedema, hypertension

Question 17

mx of TACO?

Answer 17

Slow or stop transfusion

Consider intravenous loop diuretic (e.g. furosemide) and oxygen

Question 18

what is Transfusion-related acute lung injury (TRALI)?

Answer 18

Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood

Question 19

features of TRALI?

Answer 19

Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension

Question 20

mx of TRALI?

Answer 20

Stop the transfusion

Oxygen and supportive care

Question 21

which antibodies are involved in an acute haemolytic reaction?

Answer 21

IgM - causes RBC destruction

Question 22

complications of acute haemolytic reaction?

Answer 22

DIC, renal failure

Question 23

what antibodies are involved in non-haemolytic febrile reaction?

Answer 23

WBC HLA antibodies
often the result of sensitization by previous pregnancies or transfusions

Question 24

what can you give in non-haemolytic febrile reaction?

Answer 24

paracetamol

Question 25

how do you characterise TRALI?

Answer 25

Characterised by the development of hypoxaemia / acute respiratory distress syndrome within 6 hours of transfusion.

Question 26

how do you differentiate TACO and TRALI?

Answer 26

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.

Question 27

what can infect platelet product? what’s done to mitigate this?

Answer 27

Platelets are stored at room temperature, which increases the risk of bacterial proliferation. Common contaminants include Staphylococcus epidermidis and Bacillus cereus.

Question 28

what is the risk of infection with platelet transfusion?

Answer 28

Bacterial contamination of platelets is more likely to lead to rapid onset of sepsis and septic shock, given the optimal growth conditions during storage.