Transfusion Reactions

Question 1

What are acute transfusion reactions

Answer 1

early transfusion reactions (happens straight away)

Question 2

symptoms/signs of acute transfusion reaction

Answer 2

chills 
riggers 
rash 
flushing 
feeling of impending doom 
collapse 
loin pain 
rest distress

fever
tachycardia
hypotension

MUST ACT QUICKLY

Question 3

What is the response for all transfusion reactions

Answer 3

1. STOP transfusion
2. asses patient - ABCDE
3. Re-check compatibility tag and check for evidence of contamination
4. document in medical notes

Question 4

what would a severe or life threatening transfusion reaction be

Answer 4

evidence of life threatening airway/breathing or circulatory problem

evidence of wrong component transfused/bacterial contamination

Question 5

what are the most dangerous acute haemolytic transfusion reactions

Answer 5

ABO incompatible transfusion

leads to intravascular haemolysis of transfused cells

Question 6

what is the pathophysiology behind ABO acute haemolytic transfusion reaction

Answer 6

IgM anti-A or anti-B bind to their corresponding antigen

complement activation and lysis of transfused cells

release of inflammatory cytokines (complement, kinin and coagulation systems activated)

leads to:

• shock
• increased vascular permeability
• disseminated intravascular coagulation
• renal failure
• often fatal

Question 7

how do you manage acute haemolytic transfusion reaction

Answer 7

stop transfusion - return unit to lab and inform them

supportive measures - oxygen, fluids

repeat transfusion blood samples

Question 8

what are the differentials for acute transfusion reaction

Answer 8

Acute haemolytic transfusion reaction

Bacterial contamination of blood component
-more common with platelets

Question 9

Clinical features of Transfusion Associated Circulatory Overload

Answer 9

Respiratory distress within 6 hours of transfusion

raised blood pressure

raised JVP

positive fluid balance

Question 10

risk factors for transfusion associated circulatory overload (TACO)

Answer 10

elderly patients 
cardiac failure 
low albumin 
renal impairment 
fluid overload

Question 11

Management of TACO

Answer 11

oxygen and supportive care
diuretics

consider slowing the rate of future transfusions or diuretics with future transfusions

aim to identify at risk patients before transfusion

Question 12

what are mild transfusion reactions

Answer 12

Isolated temperature rise >38 and rise of 1-2 degrees OR rash only

Question 13

management of mild transfusion reactions

Answer 13

continue transfusion

close monitoring of patient in case condition worsens

consider paracetamol/antihistamine

Question 14

causes of mild transfusion reactions

Answer 14

Febrile non-haemolytic transfusion reaction
-give paracetamol before hand

Mild allergic reaction

• rash/itch
• more common with plasma
• treat with antihistamines

Question 15

what are delayed haemolytic transfusion reactions

Answer 15

patient mounds delayed immune response to red cell antigens

• usually IgG mediated
• type IV hypersensitivity reaction

leads to extravascular haemolysis 5-10 days after transfusion

transfused cells are all destroyed

Question 16

risks of viral transmission in blood transfusion

Answer 16

rare

hep B <1:1.2 million units
HIV <1:7 million units
hep C <1:28 units