The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.
Background
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
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
- Frequently with rapid admin and large volume transfusions
- Associated with a rapid rise in blood pressure, not hypotension
- Diagnosis
- Dyspnea, orthopnea, peripheral edema, rapid rise in BP
- BNP or NT-proBNP to differentiate from other lung injury
- 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
Differential Diagnosis
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)
- ↑ Wagner, L. Why Should Clinicians Be Concerned about Blood Conservation? ITACCS. 2005 PDF