ACUTE

• Immune Mediated
• Intravascular Hemolytic Transfusion Reaction: ABO incompatibility
• **Most serious. Rare
• Fever, chills, HA, N/V, back pain, hypotension, DIC
• STOP infusion, START fluids
• Transfusion Related Acute Lung Injury (TRALI)
• **Leading cause of transfusion related mortality
• Up to 6 hours from transfusion —> bilateral pulmonary edema and hypoxemia
• Give respiratory support
• Allergic Reactions
• Anaphylaxis with IgA deficiency (very rare)
• Treatment: antihistamines and anaphylaxis care as needed
• Febrile Transfusion Reaction
• Most common, least serious
• Treatment: analgesics, antipyretics, antihistamines; usually continue transfusion
• Non-immune Mediated
• Transfusion Associated Circulatory Overload (TACO)
• Usually in elderly w/ anemia who is normovolemic —> receives too much volume
• Slow down infusion +/- diuretics (lasix 10 mg)
• Bacterial Contamination
• Rigors, vomiting, abdominal pain, fever, shock, DIC
• STOP transfusion, START abx

DELAYED

• Immune Mediated
• Extravascular Hemolytic Transfusion Reaction:non-ABO reaction
• Fever, anemia, jaundice, oliguria
• Transfusion Associated Graft vs Host Disease
• Life threatening! Rare!
• Occurs up to 30d —> fever, rash, diarrhea
• Labs abnormalities: elevated LFTS, pancytopenia
• Requires BM transplant
• Non-immune Mediated
• Transmitted Viruses: HIV, HBV, HCV, CMV (all very rare)

Reference:

Thomas, A., & Lipp, C. (2016, September 29). CRACKCast E007 – Blood and Blood Components [Audio blog post]. Retrieved November 1, 2018, from https://canadiem.org/crackcast-e007-blood-components/