Acute Transfusion Reactions

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Acute Transfusion Reactions

  1. 1. Acute Transfusion Reactions<br />Dr Omar Chughtai<br />MBBS, MD, FCAP<br />
  2. 2. Transfusion Reactions<br />Immunologic<br />Acute hemolytic reactions<br />Delayed hemolytic reactions<br />Febrile nonhemolytic reactions<br />Allergic reactions<br />Transfusion purpura<br />Non-Immunologic<br />Infections<br />Volume overload<br />Lung injury<br />Hypothermia<br />Coagulopathy.<br />
  3. 3. Acute Transfusion Reactions<br />Febrile<br />Acute Hemolytic<br />Febrile non-hemolytic<br />Bacterial sepsis<br />TRALI<br />Afebrile<br />Allergic reaction<br />Anaphylaxis<br />
  4. 4. Acute Hemolytic Reaction<br />Destruction of donor red cells by preformed recipient antibodies<br />Improper typing and crossmatching<br />Clerical error<br />
  5. 5. Acute Hemolytic Reaction<br />Fever and Chills<br />Hypotension rapidly leading to shock<br />Back pain<br />Chest tightness<br />Bleeding at transfusion site<br />Hemoglobinemia, Hemoglobinuria<br />Activation of coagulation cascade, leading to DIC<br />Selective renal vasoconstriction, leading to ATN<br />
  6. 6. Acute Hemolytic Reaction<br />STOP the transfusion!<br />Patient survival is directly affected by volume of incompatible blood transfused<br />Maintain IV access <br />Run normal saline to give volume support<br />
  7. 7. Investigation<br />Clerical check<br />Proper patient<br />Proper unit<br />Check for hemolysis: <br />Visible Hb check<br />DAT<br />Serum bilirubin rises<br />Serum haptoglobin falls <br />
  8. 8. Febrile Non-Hemolytic Reaction<br />Fever and Chills<br />1C or 2F rise in temperature<br />Patient has anti-HLA antibodies against donor white cells<br />Donor and patient white cells release pyrogenic cytokines<br />
  9. 9. Febrile Non-Hemolytic Reaction<br />Can be prevented by pre-storage leukocyte reduction<br />Less white cells in transfused unit<br />Management: <br />Stop the transfusion<br />Investigate for hemolysis<br />Pre-transfusion Acetaminophen<br />
  10. 10. Bacterial Sepsis<br />Red Cells:<br />Pseudomonas <br />Citrobacter<br />E coli<br />Platelets: <br />Staph<br />Strep<br />
  11. 11. Bacterial Sepsis<br />Rapid onset high fever<br />Fever up to 105F within 15 minutes <br />Rigors<br />Vomiting<br />Diarrhea<br />Shock<br />
  12. 12. Bacterial Sepsis<br />Management: <br />Stop the transfusion<br />IV Antibiotics<br />IV Fluids<br />Culture blood unit <br />Interview the donor<br />
  13. 13. TRALI<br />Transfusion Related Acute Lung Injury<br />Non-cardiogenic pulmonary edema<br />Respiratory distress, Fever<br />During or soon after transfusion<br />Looks like ARDS <br />
  14. 14. TRALI<br />More often seen with plasma products<br />Donor Anti-HLA and Anti-NeutrophilAb’s attack patient’s white cells<br />White cell aggregates in pulmonary vasculature<br />Pulmonary edema even though there is no volume overload<br />
  15. 15. TRALI<br />Management: <br />Respiratory support<br />Steroids<br />No diuretics<br />Patients usually recover in 24 hours<br />Donor should be tested for Anti-HLA and Anti-Neutrophil Antibodies<br />
  16. 16. Acute Allergic Reaction<br />Afebrile<br />Itching, commonly at infusion site<br />Sneezing<br />Management: <br />Stop <br />Observe<br />Anti-histamine<br />Resume slowly<br />
  17. 17. Anaphylaxis<br />Afebrile<br />Catastrophic allergic response with first few drops of blood<br />Acute systemic crash<br />Hypotension<br />Respiratory distress<br />Shock<br />
  18. 18. Anaphylaxis<br />Management: <br />Stop the transfusion<br />Epinephrine<br />IV Fluids<br />
  19. 19. Acute Crash<br />Acute Hemolytic Transfusion Reaction<br />Bacterial Sepsis<br />Anaphylaxis<br />

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