transfusion reactions Flashcards
blood transfusion complications
- immunological - acute haemolytic, non-haemolytic febrile, allergic/anaphylaxis
- infective
- transfusion related acute lung injury (TRALI)
- transfusion-assoc circulatory overload (TACO)
other - hyperkalaemia, iron overload, clotting
non-haemolytic febrile reaction pathophys
caused by antibodies reacting with white cell fragments in the blood product + cytokines that have leaked from the blood cell during storage
(due to WBC HLA antibodies)
non-haemolytic febrile reaction features
fever, chills
often result of sensitisation by previous pregnancies or transfusions
red cell transfusion (1-2%)
platelet transfusion (10-30%)
non-haemolytic febrile reaction management
slow or stop transfusion
paracetamol + monitor
minor allergic reaction pathophys
caused by foreign plasma proteins
minor allergic reaction features
pruritus, urticaria
arise within mins
minor allergic reaction management
temporarily stop transfusion
antihistamine + monitor
anaphylaxis transfusion reaction pathophys
caused by patients with IgA deficiency who have anti-IgA antibodies
anaphylaxis transfusion reaction presentation
hypotension
dyspnoea
wheezing, angioedema
arise within mins
anaphylaxis transfusion reaction management
stop transfusion
IM adrenaline
ABC support - oxyge, fluids
acute haemolytic reaction pathophys
ABO-incompatible blood causing massive intravascular haemolysis
–> eg secondary to human error
result of RBC destruction by IgM type antibodies
acute haemolytic reaction presentation
fever
**abdominal pain **
hypotension
agitation
features begin minutes after transfusion is started
acute haemolytic reaction management
stop transfusion
confirm diagnosis
- check patient name on blood product
- send blood for direct Coombs test, repeat typing + cross matching
supportive care - fluid resus
transfusion assoc circulatory overload (TACO) pathophys
excessive rate of transfusion
–> pre-existing heart failure
common
transfusion assoc circulatory overload (TACO) presentation
pulmonary oedema
hypertension -> key difference from TRALI
transfusion assoc circulatory overload (TACO) management
slow or stop transfusion
consider IV loop diuretic (furosemide)
oxygen
transfusion-related acute lung injury (TRALI) pathophys
non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donor blood
can be fatal
transfusion-related acute lung injury (TRALI) presentation
hypoxia
pulmonary infiltrates on CXR
fever
hypOtension
within 6hrs of transfusion
transfusion-related acute lung injury (TRALI) management
stop transfusion
oxygen
supportive care
complications of acute haemolytic reaction
DIC
renal failure
(due to ABO incompatibility)
why are platelets higher risk for bacterial proliferation
they’re stored at room temp, increasing risk of bacteral proliferation
can lead to sepsis/shock
common platelet contaminants
staph epidermidis
bacillus cereus
