Acute transfusion reaction: Difference between revisions

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== Acute ==
==Background==
*If concern for fluid overload, may need to transfuse as split pRBCs to tranfuse as slow as 1mL/kg/hr
*Sepsis is most commonly due to [[yersinia]], which is able to grow easily in refrigerated blood


#Intravascular Hemolytic TR
{{Transfusion risk}}
##ABO incompatability --> serious
##Sx: fever/ch/joint or back pain/shock
##Tx: stop, fluids+lasix, re-check blood
#Febrile TR
##anitbodies --> mild
##Sx: fever/ch/malaise
##Tx: R/O above
#Allergic
##Tx as allergic Rx --> range
#Transfusion-Related Acute Lung Injury (TRALI)
##Sx: acute ARDS-like injury --> severe
##Tx: stop trans, Tx as ARDS
#Sepsis (Bacterial Contamination)
#Fluid Overload


== Delayed ==
==Clinical Features==
*Etiology specific, see ddx below


#Extravascular Hemolytic TR
==Differential Diagnosis==
##days-weeks after --> mild
{{Transfusion reaction types}}
##Sx: fever/anemia/jaundice
##Tx: none
#Graft-vs-Host
##in leukemia/lymphoma pt if given trans after chemo (use leuk-poor components)
##Sx: fever/rash/n/v/inc LFTs/pancytopenia --> severe
##Tx: no effective Tx --> death
#Hemosiderosis


== Transfusion Risk Ratios ==
{{Acute Allergic DDX}}


#1:10 Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
==Evaluation==
#1:100 Minor allergic reactions (urticaria)
*Workup of hemolytic reaction
#1:300 Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
**CBC with microscopy differential
#1:700 Transfusion-associated circulatory overload per transfusion  episode
**Formal urinalysis with bilirubin
#1:5000 Transfusion-related acute lung injury (TRALI)
**Haptoglobin, LDH, free hemoglobin
#1:7000 Delayed hemolytic transfusion reaction
**Serum total and direct bilirubin
#1: 10,000 Symptomatic bacterial sepsis per pool of 5 donor units of platelets
**Coombs test of pre-transfusion and post-transfusion blood
#1:40,000 Death from bacterial sepsis per pool of 5 donor units of platelets
[[File:Coombs.png|thumbnail]]
#1:40,000 ABO-incompatible transfusion per RBC transfusion episode
*Consider CXR to help differentiate anaphylaxis, TRALI, TACO
#1:40,000 Serious allergic reaction per unit of component
{{TRALI vs TACO}}
#1: 82,000 Transmission of hepatitis B virus per unit of component
#1:100,000 Symptomatic bacterial sepsis per unit of RBC
#1:500,000 Death from bacterial sepsis per unit of RBC
#1:1,000,000 Transmission of West Nile Virus
#1:3,000,000 Transmission of HTLV per unit of component
#1:3,100,000 Transmission of hepatitis C virus per unit of component
#1:4,700,000 Transmission of HIV per unit of component


==Management==
*For all reactions:
**Stop the transfusion (at least temporarily)
**Call the blood bank
**Draw a new type + screen


== Source  ==
==Disposition==


#2/18/06 DONALDSON (adapted from Rosen)
==See Also==
#Canadian Blood Services (Public Health Agency of Canada)
{{Transfusion reactions see also}}
 
==References==
<references/>


[[Category:Heme/Onc]]
[[Category:Heme/Onc]]

Latest revision as of 14:25, 19 September 2017

Background

  • If concern for fluid overload, may need to transfuse as split pRBCs to tranfuse as slow as 1mL/kg/hr
  • Sepsis is most commonly due to yersinia, which is able to grow easily in refrigerated blood

Transfusion Risk Ratios[1]

Rate Complication
1:10 Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
1:100 Minor allergic reactions (urticaria)
1:300 Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
1:700 Transfusion-associated circulatory overload per transfusion episode
1:5,000 Transfusion-related acute lung injury (TRALI)
1:7,000 Delayed hemolytic transfusion reaction
1:10,000 Symptomatic bacterial sepsis per pool of 5 donor units of platelets
1:40,000 Death from bacterial sepsis per pool of 5 donor units of platelets
1:40,000 ABO-incompatible transfusion per RBC transfusion episode
1:40,000 Serious allergic reaction per unit of component
1:82,000 Transmission of hepatitis B virus per unit of component
1:100,000 Symptomatic bacterial sepsis per unit of RBC
1:500,000 Death from bacterial sepsis per unit of RBC
1:1,000,000 Transmission of West Nile Virus
1:3,000,000 Transmission of HTLV per unit of component
1:3,100,000 Transmission of hepatitis C virus per unit of component
1:4,700,000 Transmission of HIV per unit of component

Clinical Features

  • Etiology specific, see ddx below

Differential Diagnosis

Transfusion Reaction Types

Acute allergic reaction

Evaluation

  • Workup of hemolytic reaction
    • CBC with microscopy differential
    • Formal urinalysis with bilirubin
    • Haptoglobin, LDH, free hemoglobin
    • Serum total and direct bilirubin
    • Coombs test of pre-transfusion and post-transfusion blood
Coombs.png
  • Consider CXR to help differentiate anaphylaxis, TRALI, TACO

TRALI vs TACO

TRALI TACO
Onset Acute, within 6hrs Often more gradual
BP Low High
Temp Febrile Normal
JVD/pedal edema Unlikely Likely
CVP/PAWP Normal Elevated
BNP Normal Elevated
Resp Dyspneic Dyspneic
CXR B/l infiltrates B/l infiltrates

Management

  • For all reactions:
    • Stop the transfusion (at least temporarily)
    • Call the blood bank
    • Draw a new type + screen

Disposition

See Also

References

  1. ↑ Wagner, L. Why Should Clinicians Be Concerned about Blood Conservation? ITACCS. 2005 PDF
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