Acute transfusion reaction: Difference between revisions
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#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== | |||
[[Transfusions]] | |||
== Source == | == Source == |
Revision as of 08:04, 29 February 2012
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
- Stop transfusion
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-Related Acute Lung Injury (TRALI)
- Due to granulocyte recruitment and degranulation within the lung
- More common with FFP and plt tranfusions (extremely rare with pRBC transfusion alone)
- 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
- Occurs in leukemia/lymphoma or immunocompromised
- Diagnosis
- Fever, rash, N/V
- 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)