Acute transfusion reaction

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Acute

  1. Intravascular Hemolytic TR
    1. ABO incompatability --> serious
    2. Sx: fever/ch/joint or back pain/shock
    3. Tx: stop, fluids+lasix, re-check blood
  2. Febrile TR
    1. anitbodies --> mild
    2. Sx: fever/ch/malaise
    3. Tx: R/O above
  3. Allergic
    1. Tx as allergic Rx --> range
  4. Transfusion-Related Acute Lung Injury (TRALI)
    1. Sx: acute ARDS-like injury --> severe
    2. Tx: stop trans, Tx as ARDS
  5. Sepsis (Bacterial Contamination)
  6. Fluid Overload

Delayed

  1. Extravascular Hemolytic TR
    1. days-weeks after --> mild
    2. Sx: fever/anemia/jaundice
    3. Tx: none
  2. Graft-vs-Host
    1. in leukemia/lymphoma pt if given trans after chemo (use leuk-poor components)
    2. Sx: fever/rash/n/v/inc LFTs/pancytopenia --> severe
    3. Tx: no effective Tx --> death
  3. Hemosiderosis

Transfusion Risk Ratios

  1. 1:10 Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
  2. 1:100 Minor allergic reactions (urticaria)
  3. 1:300 Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
  4. 1:700 Transfusion-associated circulatory overload per transfusion episode
  5. 1:5000 Transfusion-related acute lung injury (TRALI)
  6. 1:7000 Delayed hemolytic transfusion reaction
  7. 1: 10,000 Symptomatic bacterial sepsis per pool of 5 donor units of platelets
  8. 1:40,000 Death from bacterial sepsis per pool of 5 donor units of platelets
  9. 1:40,000 ABO-incompatible transfusion per RBC transfusion episode
  10. 1:40,000 Serious allergic reaction per unit of component
  11. 1: 82,000 Transmission of hepatitis B virus per unit of component
  12. 1:100,000 Symptomatic bacterial sepsis per unit of RBC
  13. 1:500,000 Death from bacterial sepsis per unit of RBC
  14. 1:1,000,000 Transmission of West Nile Virus
  15. 1:3,000,000 Transmission of HTLV per unit of component
  16. 1:3,100,000 Transmission of hepatitis C virus per unit of component
  17. 1:4,700,000 Transmission of HIV per unit of component


Source

  1. 2/18/06 DONALDSON (adapted from Rosen)
  2. Canadian Blood Services (Public Health Agency of Canada)