Transfusion reactions


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  • allergic
  • Urticaria
  • Transfusion reactions

    1. 1. Namrata Dass
    2. 2. Objectives <ul><li>Early identification of common transfusion reaction </li></ul><ul><li>To differentiate severe from benign transfusion reaction </li></ul><ul><li>Management of transfusion </li></ul>
    3. 3. Introduction
    4. 4. Case scenario 2 <ul><li>A 35-year-old woman was hospitalized for anemia 2/2 sickle cell disease, she is receiving 2 units of PRBC. Her 1 st unit of blood was transfused without events but 5minutes into her 2 nd unit, She complains of new flank pain and fever. </li></ul><ul><li>On exam she appears very anxious, diaphoretic and in acute distress, she is febrile to 38.8C with Bp 100/60mmHg, HR 101 bpm, 18cpm, Pox 98% 0n RA </li></ul><ul><li>She has no skin rash but is oozing out of IV sites and her urine color is now reddish brown. </li></ul><ul><li>Labs: elevated Bun/creat, increased PTT, PT and decreased HCT. </li></ul><ul><li>What is the diagnosis and how would you manage this patient? </li></ul>
    5. 5. Hemolytic reaction <ul><li>Medical emergency </li></ul><ul><li>Caused by preformed antibodies in recipient </li></ul><ul><li>Intravascular hemolysis of transfused RBC </li></ul><ul><li>Presentation : fever , chills, back pain, nausea, vomiting </li></ul><ul><li>Management: </li></ul><ul><li>-stop the transfusion </li></ul><ul><li>-maintain urine output at 100ml/hr or greater with IV fluids or diuretics if necessary </li></ul>
    6. 6. Management <ul><li>-clotted samples of patients blood should be delivered to blood bank along with remainder of suspected unit for repeat of cross match </li></ul><ul><li>-direct and indirect Coombs test </li></ul><ul><li>-plasma and freshly voided urine should be examined for free Hb </li></ul><ul><li>COMPLICATIONS: DIC,ARF secondary to ATN </li></ul>
    7. 7. Delayed Hemolytic Transfusion Reaction <ul><li>3-10 days after transfusion </li></ul><ul><li>Caused by primary or amnestic antibody response to specific RBC antigens on donor RBCs </li></ul><ul><li>Positive Coombs test </li></ul><ul><li>s/s: low grade fever, falling Hb, icterus, </li></ul><ul><li>Management: </li></ul><ul><li>-none in absence of rapid hemolysis </li></ul><ul><li>-treat as acute hemolytic reaction if severe </li></ul>
    8. 8. Case scenario 1 <ul><li>A 35-year-old woman was hospitalized for anemia 2/2 sickle cell disease, she is receiving 2 units of PRBC. After her 1 st unit of blood she developed a temp of 38.3 °C (101.0°F). She has no other symptoms. </li></ul><ul><li>On exam she appears anxious but her vital signs are stable with Bp 120/70mmHg, HR 80bpm 18cpm Pox 98% 0n RA </li></ul><ul><li>She has no skin rash and her urine color is amber </li></ul><ul><li>What are your differential diagnosis and how would you manage this pxt? </li></ul>
    9. 9. Non hemolytic febrile transfusion reaction <ul><li>Cause by cytokines released from white cells </li></ul><ul><li>s/s: fever, chills </li></ul><ul><li>Treatment: tylenol </li></ul><ul><li>Decreased incidence from leukoreduced products </li></ul>
    10. 10. Allergic reactions <ul><li>Caused by plasma proteins that elicit an Ig E mediated response </li></ul><ul><li>s/s: urticaria, hypotension, bronchospasm </li></ul><ul><li>Treatment depends on the presentation. </li></ul><ul><li>Mild urticaria treated with diphenhydramine. </li></ul><ul><li>Severe anaphylaxis is an emergency, treated with epinephrine </li></ul>
    11. 12. Volume overload <ul><li>Presents with signs of overload especially in patients with cardiovascular compromise </li></ul><ul><li>Treated by slowing the rate of transfusion and judicious use of diuretics </li></ul>
    12. 13. Transfusion related acute lung injury <ul><li>Occurs with 4hrs of transfusion </li></ul><ul><li>Caused by anti human leukocyte antigen (HLA) or anti granulocyte antibody in the donor’s serum directed to recipient’s white blood cell </li></ul><ul><li>s/s:dyspnea, hypotension , fever, chills, hypoxemia </li></ul><ul><li>Management: </li></ul><ul><li>-stop transfusion </li></ul><ul><li>-report blood bank </li></ul><ul><li>-Supportive: oxygen, PEEP </li></ul>
    13. 14. Criteria for TRALI <ul><li>Acute onset of lung injury </li></ul><ul><li>Measured PA occlusion pressure ≤18 mm Hg or a lack of clinical evidence of left atrial hypertension (ie, no circulatory overload) </li></ul><ul><li>Bilateral pulmonary infiltrates seen on frontal chest radiograph </li></ul><ul><li>Hypoxemia: PaO2/FIO2 <300 mm Hg, or O2 saturation ≤90 percent on room air </li></ul><ul><li>Within 6hrs of transfusion </li></ul>
    14. 16. Transfusion related graft versus host disease <ul><li>Caused due to infusion of immunocompetent T lymphocytes in immunocompromised pts </li></ul><ul><li>s/s:rash,elevated liver function test, severe pancytopenia </li></ul><ul><li>Irradiation of blood products prevents this. </li></ul>
    15. 17. Clinical Presentation <ul><li>Skin : Swollen, erythroderma and bullae formation- most common </li></ul><ul><li>GI : Diarrhea and abdominal cramps </li></ul><ul><li>Liver: Elevated LFT and Hyperbilirubinemia </li></ul><ul><li>Heme : Bone marrow aplasia, persistent thrombocytopenia </li></ul>Skin manifestation of GVHD Generalized swelling, erythroderma and bullous formation
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