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
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
|
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
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