Transfusion Reactions

Question 1

What is “SHOT”?

Answer 1

Serious Hazards of Transfusion

Question 2

What are the symptoms of acute transfusion reactions?

Answer 2

Chills
Rigor
Rash
Flushing
Feeling of impending doom
Collapse
Loin pain
Resp distress
Fever
Tachy
Hypotensive

Question 3

What is the action for ALL transfusion reactions?

Answer 3

STOP transfusion
Assess patient via ABCDE
Re-check compatibility tags and inspect pack for evidence of contamination
Document events in medical notes

Question 4

What are signs of severe/ life threatening reactions?

Answer 4

Evidence of life threatening airway/ breathing or circulatory problem
Evidence of wrong component transfused/ bacterial contamination

Question 5

What is the most dangerous acute haemolytic transfusion reaction (AHTR)?

Answer 5

ABO incompatibility

Intravascular haemolysis of transfused cells

Question 6

What is the pathophysiology of AHTR?

Answer 6

Binding of IgM anti-A or -B antibodies to their corresponding antigen leading to complement activation and lysis of transfused cells
Release of inflammatory cytokines

Question 7

What is the action of cytokine release in AHTR?

Answer 7

Complement, kinin and coag systems activated
Shock, increased vascular permeability, DIC, renal failure
Often FATAL

Question 8

What is the clinical management of AHTR?

Answer 8

Stop transfusion and return unti to transfusion lab
Supportive measures; oxygen, fluid
Repeat transfusion blood samples
Bloods for FBC, coag scree, renal function, haemolysis screen, blood cultures

Question 9

What is the transfusion lab management of AHTR?

Answer 9

Repeat ABO and RhD group of pre and post transfusion samples
Direct antiglobulin test
Repeat crossmatch
Send remains of unit for culture

Question 10

What is the ddx of severe ATR?

Answer 10

Acute haemolytic reaction 
Bacterial contamination (commoner with platelet transfusions)

Question 11

What are the clinical features of transfusion associated circulatory overload (TACO)?

Answer 11

Resp distress within 6 hours of transfusion
Raised BP
Raised JVP
Positive fluid balance

Question 12

What are risk factors for TACO?

Answer 12

Elderly patient 
Cardiac failure 
Low albumin 
Renal impairment
Fluid overload

Question 13

What is the management of TACO?

Answer 13

Oxygen and supportive care
Diuretics
Consider slowing rate of further transfusions
Consider diuretic with future transfusion
Only transfuse minimum vol required

Question 14

What are mild transfusion reactions?

Answer 14

Isolated temp rise >38 and rise of 1-2 degrees or rash only

Question 15

What is the management of a mild transfusion reaction?

Answer 15

Continue transfusion but slow down
Close monitoring of patient
Consider paracetamol/ anti-histamine

Question 16

What can cause a mild transfusion reaction?

Answer 16

Febrile non-haemolytic transfusion reaction:
Less common since universal leucodepletion
Consider pre-medication with paracetamol if patient suffers repeat reactions
Mild allergic reaction:
Rash/itch but all other obs normal
Commoner with plasma rich components
Treat with anti-histamines

Question 17

What is a delayed haemolytic transfusion reaction?

Answer 17

Patient mounts delayed immune response to red cell antigen; IgG
Positive DAT
Extravascular haemolysis 5-10 days post transfusion

Question 18

What are the signs of a delayed haemolytic transfusion reaction?

Answer 18

Hb dropped
Raised bili
LDH
Positive DAT and detection of alloantibody

Question 19

Is viral transmission via blood transfusion common?

Answer 19

Rare:
Hep B <1:1.2 millions units
HIV <1:7 million units
Hep C <1:28 million units

Question 20

How much should one unit of red packed cells increased the Hb?

Answer 20

10-15 g/L

Question 21

What are the symptoms of TRALI (transfusion related acute lung injury)?

Answer 21

Dyspnoea
Cough
CXR
“White out”

Question 22

What is the management of TRALI?

Answer 22

STOP transfusion
Give 100% O2
Treat as ARDS