Acute transfusion reaction: Difference between revisions
No edit summary |
|||
Line 10: | Line 10: | ||
*Treatment | *Treatment | ||
**Stop transfusion | **Stop transfusion | ||
**Replace all tubing | |||
***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 (1-2 mL/kg/hr), 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 |
Revision as of 20:54, 21 February 2015
Background
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 |
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
- Replace all tubing
- Risk of death is proportional to amount of incompatible blood received
- Maintain urine output with IVF (1-2 mL/kg/hr), 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
Management
- For all reactions:
- Stop the transfusion (at least temporaily)
- Call the blood bank
- Draw a new type + screen
See Also
Source
- Tintinalli
- Canadian Blood Services (Public Health Agency of Canada)