Difference between revisions of "Acute transfusion reaction"

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== Acute ==
 
== Acute ==
===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
 
 
 
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Revision as of 20:54, 4 February 2016

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

Differential Diagnosis

Transfusion Reaction Types

Acute

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

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

Graft-vs-host disease

Differential Diagnosis

Acute allergic reaction

Management

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

See Also

References

  • Canadian Blood Services (Public Health Agency of Canada)
  1. Wagner, L. Why Should Clinicians Be Concerned about Blood Conservation? ITACCS. 2005 PDF