Transfusion Reactions

Question 1

What types of transfusion reactions are there?

Answer 1

Acute haemolytic transfusion reaction
Allergic/ anaphylaxis
Febrile non-haemolytic transfusion reactions
Transfusion related acute lung injury (TRALI)
Transfusion related fluid overload (TACO)
GvHD
Bacterial contamination - greatest risk with platelets

Question 2

What causes an acute haemolytic transfusion reaction?

Answer 2

Intravascular haemolysis usually due to ABO incompatible reaction

Question 3

When do symptoms occur after an acute haemolytic transfusion reaction?

Answer 3

Minutes after transfusion started

Question 4

What symptoms occur with an acute haemolytic transfusion reaction?

Answer 4

Fever
Hypotension 
Tachycardia 
Flank pain 
Haemoglobinuria

Question 5

Why can an allergic/ anaphylactic reaction occur?

Answer 5

Due to reaction to components within transfusion e.g foreign plasma proteins or antibodies to IgA

Question 6

What symptoms are seen in allergic/ anaphylactic reaction?

Answer 6

Urticaria
Pruritis 
Angioedema 
Hypotension 
Wheezing

Question 7

What is a febrile non-haemolytic transfusion reaction?

Answer 7

More than 1 degree increase in temperature with no other medical explanation.
- may also have slight increase in pulse and respirations

• can be due to cytokines released in blood products or due to sensitisation by previous pregnancies or transfusions

Question 8

What is transfusion related acute lung injury (TRALI) thought to be due to?

Answer 8

Transfused leukocyte antibodies

Question 9

What symptoms can TRALI cause?

Answer 9

Dyspnoea
Hypoxia
Non- cardiogenic pulmonary oedema

Question 10

Is it easy to distinguish between TRALI and TACO?

Answer 10

Not always

Question 11

What is TACO?

Answer 11

Fluid overload resulting in pulmonary oedema

• as well as features of pulmonary oedema, patient may also be hypertensive

Question 12

Who is at risk of transfusion associated graft versus host disease?

Answer 12

Immunosuppressed patients

Question 13

What features should alert you to an acute transfusion reaction?

Answer 13

Increased temperature 
Collapse
Pain - chest, loins, back, extremities
Rigors
Anaphylaxis 
Shivering
Drop in BP
SOB
Flushing
Burning pain at drip site
Bleeding from drip site
Patient reports general feeling of apprehension 
Non specific deterioration in patient condition 
Dizziness

Question 14

What is the first thing that should be done if patient exhibiting possible features of an acute transfusion reaction?

Answer 14

STOP THE TRANSFUSION

Rapid clinical assessment, check patient ID/blood compatibility label

Inspect - examine component bag for abnormal appearance (clumps, particles, discolouration) and check IV site for infection

Question 15

If patient having an anaphylactic reaction, what should you do?

Answer 15

STOP TRANSFUSION

Anaphylaxis pathway
Oxygen
Give IM adrenaline

Question 16

If acute haemolytic transfusion reaction or sepsis, what should be done?

Answer 16

IV saline

Sepsis pathway if sepsis

Question 17

If patient is breathless what may be reason?

Answer 17

Related to transfusion or underlying illness?
TACO
TRALI
Anxiety

Question 18

What initial investigations should be done if patient breathless?

Answer 18

Stop transfusion 
Check identity 
Maintain venous access
Oxygen sats 
CXR
ECG

Question 19

What are the early features of transfusion associated graft versus host disease?

Answer 19

Fever
Maculopapular rash
Diarrhoea
Hepatitis

Bone marrow involvement - profound pancytopenia (death from infection usually within 2-3weeks)

Question 20

Does pre storage leukocyte depletion totally remove risk of TA GvHD?

Answer 20

No - at risk patients need irradiated red cells, platelets and granulocyte concentrates