Difference between revisions of "Acute transfusion reaction"

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==Acute==
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==Background==
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*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
  
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{{Transfusion risk}}
  
1) Intravascular Hemolytic TR
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==Clinical Features==
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*Etiology specific, see ddx below
  
-ABO inconpatability --> serious
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==Differential Diagnosis==
 +
{{Transfusion reaction types}}
  
-Sx: fever/ch/joint or back pain/shock
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{{Acute Allergic DDX}}
  
-Tx: stop, fluids+lasix, re-check blood
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==Evaluation==
 +
*Workup of hemolytic reaction
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**CBC with microscopy differential
 +
**Formal urinalysis with bilirubin
 +
**Haptoglobin, LDH, free hemoglobin
 +
**Serum total and direct bilirubin
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**Coombs test of pre-transfusion and post-transfusion blood
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[[File:Coombs.png|thumbnail]]
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*Consider CXR to help differentiate anaphylaxis, TRALI, TACO
 +
{{TRALI vs TACO}}
  
2) Febrile TR
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==Management==
 
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*For all reactions:
-anitbodies --> mild
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**Stop the transfusion (at least temporarily)
 
+
**Call the blood bank
-Sx: fever/ch/malaise
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**Draw a new type + screen
 
 
-Tx: R/O above
 
 
 
3) Allergic
 
 
 
-Tx as allergic Rx --> range
 
 
 
4) Transfusion-Related Acute Lung Injury (TRALI)
 
 
 
-Sx: acute ARDS-like injury --> severe
 
 
 
-Tx: stop trans, Tx as ARDS
 
 
 
5) Sepsis (Bacterial Contamination)
 
 
 
6) Fluid Overload
 
 
 
 
 
 
==Delayed==
 
 
 
 
 
1) Extravascular Hemolytic TR
 
 
 
-days-weeks after --> mild
 
 
 
-Sx: fever/anemia/jaundice
 
 
 
-Tx: none
 
 
 
2) 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
 
 
 
3) Hemosiderosis
 
 
 
 
 
 
==Source ==
 
 
 
 
 
2/18/06 DONALDSON (adapted from Rosen)
 
  
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==Disposition==
  
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==See Also==
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{{Transfusion reactions see also}}
  
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==References==
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<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