Back to Basics: Transfusion Related Reactions
Mon, 11/26/2018 - 12:56am
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/