Difference between revisions of "Acute transfusion reaction"

(Differential Diagnosis)
(Management)
 
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==Background==
 
==Background==
 +
*If concern for fluid overload, may need to transfuse as split pRBCs to tranfuse as slow as 1mL/kg/hr
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*Sepsis is most commonly due to [[yersinia]], which is able to grow easily in refrigerated blood
 +
 
{{Transfusion risk}}
 
{{Transfusion risk}}
  
*Fluid Overload
+
==Clinical Features==
**Split pRBCs to tranfuse more slowly (as slow as 1mL/kg/hr)
+
*Etiology specific, see ddx below
*Sepsis
 
**Most commonly due to yersinia which is able to grow easily in refrigerated blood
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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{{Acute Allergic DDX}}
 
{{Acute Allergic DDX}}
  
==Differential Diagnosis==
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==Evaluation==
{{Acute Allergic DDX}}
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*Workup of hemolytic reaction
 
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**CBC with microscopy differential
==Diagnosis==
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**Formal urinalysis with bilirubin
{| class="wikitable"
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**Haptoglobin, LDH, free hemoglobin
| align="center" style="background:#f0f0f0;"|''' '''
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**Serum total and direct bilirubin
| align="center" style="background:#f0f0f0;"|'''TRALI'''
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**Coombs test of pre-transfusion and post-transfusion blood
| align="center" style="background:#f0f0f0;"|'''TACO'''
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[[File:Coombs.png|thumbnail]]
|-
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*Consider CXR to help differentiate anaphylaxis, TRALI, TACO
| Onset||Acute, within 6hrs||Often more gradual
+
{{TRALI vs TACO}}
|-
 
| 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==
 
==Management==
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**Call the blood bank
 
**Call the blood bank
 
**Draw a new type + screen
 
**Draw a new type + screen
 +
 +
==Disposition==
  
 
==See Also==
 
==See Also==

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