Difference between revisions of "Acute transfusion reaction"

m (Rossdonaldson1 moved page Transfusion Reactions to Transfusion reaction)
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==Background==
 
==Background==
#For all reactions:
+
*For all reactions:
##Stop the transfusion (at least temporaily)
+
**Stop the transfusion (at least temporaily)
##Call the blood bank
+
**Call the blood bank
##Draw a new type + screen
+
**Draw a new type + screen
  
 
== Acute ==
 
== Acute ==
 
===Intravascular Hemolytic Tranfusion Reaction===
 
===Intravascular Hemolytic Tranfusion Reaction===
#Occurs due to ABO incompatibility
+
*Occurs due to ABO incompatibility
#Diagnosis
+
*Diagnosis
##Back pain, headache, hypotension, dyspnea, pulmonary edema, bleeding, renal failure
+
**Back pain, headache, hypotension, dyspnea, pulmonary edema, bleeding, renal failure
##Labs c/w hemolysis
+
**Labs c/w hemolysis
#Treatment
+
*Treatment
##Stop transfusion
+
**Stop transfusion
###Risk of death is proportional to amount of incompatible blood received
+
***Risk of death is proportional to amount of incompatible blood received
##Maintain urine output with IVF, mannitol, and furosemide as needed
+
**Maintain urine output with IVF, mannitol, and furosemide as needed
##Treat shock with volume and vasopressors
+
**Treat shock with volume and vasopressors
##Treat coagulopathy w/ FFP
+
**Treat coagulopathy w/ FFP
 
===Febrile Nonhemolytic Tranfusion Reaction===
 
===Febrile Nonhemolytic Tranfusion Reaction===
#Occurs in 20% of pts due to recipient Ab against donor leukocytes
+
*Occurs in 20% of pts due to recipient Ab against donor leukocytes
#Diagnosis
+
*Diagnosis
##Fever, HA, myalgias, tachycardia, dyspnea, chest pain
+
**Fever, HA, myalgias, tachycardia, dyspnea, chest pain
#Treatment
+
*Treatment
##Stop tranfusion pending rule-out of hemolytic transfusion reaction
+
**Stop tranfusion pending rule-out of hemolytic transfusion reaction
##Give antipyretic
+
**Give antipyretic
##Restart transfusion once hemolytic transfusion reaction is ruled-out
+
**Restart transfusion once hemolytic transfusion reaction is ruled-out
 
===Allergic Tranfusion Reaction===
 
===Allergic Tranfusion Reaction===
#Occurs due to immune response to plasma proteins
+
*Occurs due to immune response to plasma proteins
#Diagnosis
+
*Diagnosis
##Symptoms range from urticaria/pruritus to bronchospasm, wheezing, anaphylaxis (rare)
+
**Symptoms range from urticaria/pruritus to bronchospasm, wheezing, anaphylaxis (rare)
#Treatment
+
*Treatment
##Stop transfusion until able to evaluate severity of allergic reaction
+
**Stop transfusion until able to evaluate severity of allergic reaction
##Give diphenhydramine
+
**Give diphenhydramine
##Restart transfusion if symptoms are mild
+
**Restart transfusion if symptoms are mild
 
===Transfusion-associated circulatory overload (TACO)===
 
===Transfusion-associated circulatory overload (TACO)===
#Often confused with TRALI
+
*Often confused with TRALI
#Associated with a rapid rise in blood pressure, not hypotension
+
*Associated with a rapid rise in blood pressure, not hypotension
#Diagnosis
+
*Diagnosis
##Dyspnea, orthopnea, peripheral edema, rapid rise in BP
+
**Dyspnea, orthopnea, peripheral edema, rapid rise in BP
#Treatment
+
*Treatment
##O2, supportive care, diuretics
+
**O2, supportive care, diuretics
 
===Transfusion-Related Acute Lung Injury (TRALI)===
 
===Transfusion-Related Acute Lung Injury (TRALI)===
#Due to granulocyte recruitment and degranulation within the lung
+
*Due to granulocyte recruitment and degranulation within the lung
#More common with FFP and plt transfusions (extremely rare with pRBC transfusion alone)
+
*More common with FFP and plt transfusions (extremely rare with pRBC transfusion alone)
##pRBCs do contain residual plasma and can have TRALI
+
**pRBCs do contain residual plasma and can have TRALI
#Time Frame: abrupt to within 6 hours of transfusion initiation
+
*Time Frame: abrupt to within 6 hours of transfusion initiation
#Diagnosis
+
*Diagnosis
##ARDS-like symptoms
+
**ARDS-like symptoms
##B/l pulmonary infiltrates due to noncardiogenic pulmonary edema w/in 6h of transfusion
+
**B/l pulmonary infiltrates due to noncardiogenic pulmonary edema w/in 6h of transfusion
#Treatment
+
*Treatment
##Strop transfusion
+
**Strop transfusion
##Treat like ARDS
+
**Treat like ARDS
##Avoid diuresis
+
**Avoid diuresis
  
 
===Fluid Overload===
 
===Fluid Overload===
#Split pRBCs to tranfuse more slowly (as slow as 1mL/kg/hr)
+
*Split pRBCs to tranfuse more slowly (as slow as 1mL/kg/hr)
 
===Sepsis===
 
===Sepsis===
#Most commonly due to yersinia which is able to grow easily in refrigerated blood
+
*Most commonly due to yersinia which is able to grow easily in refrigerated blood
 
== Delayed ==
 
== Delayed ==
 
===Extravascular Hemolytic Tranfusion Reaction===
 
===Extravascular Hemolytic Tranfusion Reaction===
#Occurs days to weeks after transfusion
+
*Occurs days to weeks after transfusion
#Hemolysis occurs in spleen, liver, and bone marrow
+
*Hemolysis occurs in spleen, liver, and bone marrow
#Diagnosis
+
*Diagnosis
##Hyperbilirubinemia
+
**Hyperbilirubinemia
##Poor response to transfusion
+
**Poor response to transfusion
#Treatment
+
*Treatment
##None necessary; rarely fatal
+
**None necessary; rarely fatal
 
===Graft-vs-Host Disease===
 
===Graft-vs-Host Disease===
 
*Acute vs Chronic
 
*Acute vs Chronic
 
**Acute: 1-12 weeks post graft
 
**Acute: 1-12 weeks post graft
 
**Chronic: >12 weeks
 
**Chronic: >12 weeks
#Transplanted graft with immunologically competent cells stimulated by host antigens and host is incapable of mounting an effective immunologic response
+
*Transplanted graft with immunologically competent cells stimulated by host antigens and host is incapable of mounting an effective immunologic response
#Occurs in leukemia/lymphoma or immunocompromised
+
*Occurs in leukemia/lymphoma or immunocompromised
#Diagnosis
+
*Diagnosis
##Nonspecific rash, mucositis, fever, and diarrhea
+
**Nonspecific rash, mucositis, fever, and diarrhea
##LFT abnormalities, pancytopenia
+
**LFT abnormalities, pancytopenia
#Treatment
+
*Treatment
##Glucocorticoids
+
**Glucocorticoids
  
 
== Transfusion Risk Ratios ==
 
== Transfusion Risk Ratios ==
#1:10 Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
+
*1:10 Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
#1:100 Minor allergic reactions (urticaria)
+
*1:100 Minor allergic reactions (urticaria)
#1:300 Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
+
*1:300 Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
#1:700 Transfusion-associated circulatory overload per transfusion  episode
+
*1:700 Transfusion-associated circulatory overload per transfusion  episode
#1:5000 Transfusion-related acute lung injury (TRALI)
+
*1:5000 Transfusion-related acute lung injury (TRALI)
#1:7000 Delayed hemolytic transfusion reaction
+
*1:7000 Delayed hemolytic transfusion reaction
#1:10,000 Symptomatic bacterial sepsis per pool of 5 donor units of platelets
+
*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 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 ABO-incompatible transfusion per RBC transfusion episode
#1:40,000 Serious allergic reaction per unit of component
+
*1:40,000 Serious allergic reaction per unit of component
#1: 82,000 Transmission of hepatitis B virus 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
+
*1:100,000 Symptomatic bacterial sepsis per unit of RBC
#1:500,000 Death from 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
+
*1:1,000,000 Transmission of West Nile Virus
#1:3,000,000 Transmission of HTLV per unit of component  
+
*1:3,000,000 Transmission of HTLV per unit of component  
#1:3,100,000 Transmission of hepatitis C virus per unit of component  
+
*1:3,100,000 Transmission of hepatitis C virus per unit of component  
#1:4,700,000 Transmission of HIV per unit of component
+
*1:4,700,000 Transmission of HIV per unit of component
  
 
==See Also==
 
==See Also==
[[Transfusions]]
+
*[[Transfusions]]
  
 
== Source  ==
 
== Source  ==

Revision as of 19:31, 17 February 2015

Background

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

Acute

Intravascular Hemolytic Tranfusion Reaction

  • Occurs due to ABO incompatibility
  • Diagnosis
    • Back pain, headache, hypotension, dyspnea, pulmonary edema, bleeding, renal failure
    • Labs c/w hemolysis
  • Treatment
    • Stop transfusion
      • Risk of death is proportional to amount of incompatible blood received
    • Maintain urine output with IVF, mannitol, and furosemide as needed
    • Treat shock with volume and vasopressors
    • Treat coagulopathy w/ FFP

Febrile Nonhemolytic Tranfusion Reaction

  • Occurs in 20% of pts due to recipient Ab against donor leukocytes
  • Diagnosis
    • Fever, HA, myalgias, tachycardia, dyspnea, chest pain
  • Treatment
    • Stop tranfusion pending rule-out of hemolytic transfusion reaction
    • Give antipyretic
    • Restart transfusion once hemolytic transfusion reaction is ruled-out

Allergic Tranfusion Reaction

  • Occurs due to immune response to plasma proteins
  • Diagnosis
    • Symptoms range from urticaria/pruritus to bronchospasm, wheezing, anaphylaxis (rare)
  • Treatment
    • Stop transfusion until able to evaluate severity of allergic reaction
    • Give diphenhydramine
    • Restart transfusion if symptoms are mild

Transfusion-associated circulatory overload (TACO)

  • Often confused with TRALI
  • Associated with a rapid rise in blood pressure, not hypotension
  • Diagnosis
    • Dyspnea, orthopnea, peripheral edema, rapid rise in BP
  • Treatment
    • O2, supportive care, diuretics

Transfusion-Related Acute Lung Injury (TRALI)

  • Due to granulocyte recruitment and degranulation within the lung
  • More common with FFP and plt transfusions (extremely rare with pRBC transfusion alone)
    • pRBCs do contain residual plasma and can have TRALI
  • Time Frame: abrupt to within 6 hours of transfusion initiation
  • Diagnosis
    • ARDS-like symptoms
    • B/l pulmonary infiltrates due to noncardiogenic pulmonary edema w/in 6h of transfusion
  • Treatment
    • Strop transfusion
    • Treat like ARDS
    • Avoid diuresis

Fluid Overload

  • Split pRBCs to tranfuse more slowly (as slow as 1mL/kg/hr)

Sepsis

  • Most commonly due to yersinia which is able to grow easily in refrigerated blood

Delayed

Extravascular Hemolytic Tranfusion Reaction

  • Occurs days to weeks after transfusion
  • Hemolysis occurs in spleen, liver, and bone marrow
  • Diagnosis
    • Hyperbilirubinemia
    • Poor response to transfusion
  • Treatment
    • None necessary; rarely fatal

Graft-vs-Host Disease

  • Acute vs Chronic
    • Acute: 1-12 weeks post graft
    • Chronic: >12 weeks
  • Transplanted graft with immunologically competent cells stimulated by host antigens and host is incapable of mounting an effective immunologic response
  • Occurs in leukemia/lymphoma or immunocompromised
  • Diagnosis
    • Nonspecific rash, mucositis, fever, and diarrhea
    • LFT abnormalities, pancytopenia
  • Treatment
    • Glucocorticoids

Transfusion Risk Ratios

  • 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
  • 1:5000 Transfusion-related acute lung injury (TRALI)
  • 1:7000 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

See Also

Source

  • Tintinalli
  • Canadian Blood Services (Public Health Agency of Canada)