Transfusion Reactions Flashcards
What is “SHOT”?
Serious Hazards of Transfusion
What are the symptoms of acute transfusion reactions?
Chills Rigor Rash Flushing Feeling of impending doom Collapse Loin pain Resp distress Fever Tachy Hypotensive
What is the action for ALL transfusion reactions?
STOP transfusion
Assess patient via ABCDE
Re-check compatibility tags and inspect pack for evidence of contamination
Document events in medical notes
What are signs of severe/ life threatening reactions?
Evidence of life threatening airway/ breathing or circulatory problem
Evidence of wrong component transfused/ bacterial contamination
What is the most dangerous acute haemolytic transfusion reaction (AHTR)?
ABO incompatibility
Intravascular haemolysis of transfused cells
What is the pathophysiology of AHTR?
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
What is the action of cytokine release in AHTR?
Complement, kinin and coag systems activated
Shock, increased vascular permeability, DIC, renal failure
Often FATAL
What is the clinical management of AHTR?
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
What is the transfusion lab management of AHTR?
Repeat ABO and RhD group of pre and post transfusion samples
Direct antiglobulin test
Repeat crossmatch
Send remains of unit for culture
What is the ddx of severe ATR?
Acute haemolytic reaction Bacterial contamination (commoner with platelet transfusions)
What are the clinical features of transfusion associated circulatory overload (TACO)?
Resp distress within 6 hours of transfusion
Raised BP
Raised JVP
Positive fluid balance
What are risk factors for TACO?
Elderly patient Cardiac failure Low albumin Renal impairment Fluid overload
What is the management of TACO?
Oxygen and supportive care
Diuretics
Consider slowing rate of further transfusions
Consider diuretic with future transfusion
Only transfuse minimum vol required
What are mild transfusion reactions?
Isolated temp rise >38 and rise of 1-2 degrees or rash only
What is the management of a mild transfusion reaction?
Continue transfusion but slow down
Close monitoring of patient
Consider paracetamol/ anti-histamine
What can cause a mild transfusion reaction?
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
What is a delayed haemolytic transfusion reaction?
Patient mounts delayed immune response to red cell antigen; IgG
Positive DAT
Extravascular haemolysis 5-10 days post transfusion
What are the signs of a delayed haemolytic transfusion reaction?
Hb dropped
Raised bili
LDH
Positive DAT and detection of alloantibody
Is viral transmission via blood transfusion common?
Rare:
Hep B <1:1.2 millions units
HIV <1:7 million units
Hep C <1:28 million units
How much should one unit of red packed cells increased the Hb?
10-15 g/L
What are the symptoms of TRALI (transfusion related acute lung injury)?
Dyspnoea
Cough
CXR
“White out”
What is the management of TRALI?
STOP transfusion
Give 100% O2
Treat as ARDS
