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TRANSFUSION REACTIONS
- 1. TRANSFUSION REACTIONS DR. SARAH FARRUKH MBBS, FCPS (HAEMATOLOGY) WMO, PUNJAB INSTITUTE OF CARDIOLOGY
- 2. What is a transfusion reaction? Any adverse event which occurs during or after transfusion of whole blood, blood components and human derived plasma products.
- 3. CLASSIFICATION ACUTE: Within 24 hours of transfusion DELAYED After 24 hours of transfusion
- 4. ACUTE TRANSFUSION REACTIONS Hemolytic transfusion reaction Transfusion associated sepsis Febrile non hemolytic transfusion reaction Allergic transfusion reaction Transfusion associated acute lung injury Transfusion associated circulatory overload
- 5. Presenting signs and symptoms PAIN: chest, abdominal, flanks, back or infusion site. BP: Hypotension Dark colored urine / red urine Vascular collapse (DIC) POSSIBLE REACTION HEMOLYTIC TRANSFUSION REACTION Commonly seen in ABO mismatched transfusion
- 6. Presenting signs and symptoms Rigors and chills BP: Hypotension Temperature: 2 degree rise in temperature POSSIBLE REACTION TRANSFUSION ASSOCIATED SEPSIS Commonly seen in Platelet products as they are stored at room temperature which favors bacterial growth.
- 7. Presenting signs and symptoms Chills, nausea, vomiting Temperature 1 degree Celsius rise from baseline Blood pressure: increased Tachycardia Tachypnea/ increased respiratory rate POSSIBLE REACTION FEBRILE NON HEMOLYTIC TRANSFUSION REACTION
- 8. Presenting signs and symptoms Wheals, hives, erythema Bronchoconstriction, wheeze, edema, tongue swelling, diarrhea Blood pressure: decreased Severe cases: arrythmia/ shock POSSIBLE REACTION ALLERGIC TRANSFUSION REACTION
- 9. Presenting signs and symptoms WITHIN 6 HOURS OF TRANSFUSION Blood pressure: Decreased Temperature: increased Chest Xray: Bilateral pulmonary infiltrates POSSIBLE REACTION TRANSFUSION ASSOCIATED ACUTE LUNG INJURY Commonly seen in surgical patients and multiple transfused patients
- 10. Presenting signs and symptoms Severe hypoxemia Increased blood pressure JUGULAR VEIN DISTENSION Increased central venous pressure POSSIBLE REACTION TRANSFUSION ASSOCIATED CIRCULATROY OVERLOAD
- 11. WHAT TO DO NEXT? FIRST AND FOREMOST: STOP THE TRANSFUSION
- 12. PROCEEDING STEPS Maintain IV access open with normal saline. Notify the physician Perform following checks at the bedside 1. Clerical check 2. Hemolysis check 3. Urine check
- 15. Samples to be sent to the laboratory COMPLETE BLOOD COUNTS COAGULATION PROFILE ABO GROUPING URINE COMPLETE EXAMINATION ORIGINAL BLOOD/ COMPONENRT BAG RENAL FUNCTION TESTS LDH COOMBS TEST ( ANTIBODY MEDIATED HEMOLYSIS) BLOOD CULTURES (SEPSIS) BRAIN NATRIURETIC PEPTIDE ( TACO) SERUM HAPTOGLOBIN, BILIRUBIN AND LDH ( if hemolysis is suspected)