Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Transfusion reactions


Published on

  • Be the first to comment

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