Immunoogenic Transfusion Reactions explained including GVHD, Febrile non-hemolytic, Acute & Delayed hemolytic reaction, Transfusion Associated Lung Injury.

2. BY: DR.HASEEB TARIQ

3.  Blood transfusion is a life
saving procedure and is of
immense importance.
 Sometimes due to different
factors a reaction can
occur which can have
adverse effect on the
patient.
 The objective of this
presentation is to know
different types of
transfusion reactions and
learn their management.

4.  IMMUNE MEDIATED
 NON-IMMUNE MEDIATED
IMMUNE MEDIATED REACTIONS:
 Febrile non-hemolytic
 Acute hemolytic
 Delayed hemolytic
 Anaphylactic
 GVHD
 Transfusion associated lung injury (TRALI)
 Urticarial transfusion reaction

5. NON-IMMUNNE MEDIATED:
 Heat/Cold associated injury
 Infections
 Acute hypotensive reaction
 Osmotic injury
 Chemical injury

7.  Stop the transfusion immediately
 Check & Monitor vitals
 Maintain IV access
 Notify Lab for error
 Check right pack has been transfused
 Obtain CBC report & CXR post-reaction

8.  Most common
 Occurs during or in 24hrs of transfusion
 Caused by Ab. against donor HLA antigens &
leucocytes
 DIAGNOSIS OF EXCLUSION: Fever may be the
only symptom and may show a delayed
reaction!!

9. SYMPTOMS:
 FEVER
 DYSPNOEA
Consider and exclude other causes, as fever
alone may be the first manifestation of a life
threatening reaction.
INVESTIGATIONS:
 Clinically assess for Rigors & Chills
 Repeat ABO compatibility
 Exclude hemolytic reaction
 Investigate for sepsis

10.  Treat the fever with an antipyretic.
 Avoid aspirin in thrombocytopenic and
paediatric patients.
 Follow general management for the reaction.

11.  Medical Emergency!!
 Transfused red cells are destroyed, due to
incompatibility of antigen on transfused cells
with antibody in the recipient circulation.
 Occurs in 24 hrs of transfusion or during
transfusion.
 Mostly caused due to human error.

12. Signs & Symptoms:
 Haemolysis
 Haemoglobinuria
 Back pain
 Fever
 ARF
 DIC
INVESTIGATIONS:
 Clinically assess patient
 Check clerical records for error
 DAT, IAT
 RFTs, Serum.Haptoglobulin
 Repeat ABO and screening

13. MANAGEMENT:
 Stop transfusion immediately and follow
other steps for managing suspected
transfusion reactions.
 Seek urgent medical assistance.
 Maintain blood pressure and renal output.
 Induce diuresis with intravenous fluids and
diuretics.
 This may become a medical emergency so
support blood pressure and maintain an open
airway.
 Do not administer additional blood packs
until cleared by haematologist or Transfusion
Service Provider.

14.  Generally occurs 2-10 days after transfusion.
 One way this can occur is if a person without
a Kidd blood antigen receives a Kidd antigen
in a transfusion.
 DEFINITION:It is defined as fever and other
symptoms/ signs of hemolysis more than 24
hours after transfusion.

15. CRITERIA:
 Fall in Hb or failure to rise post-transfusion.
 Rise in billrubin (jaundice)
 In-compatible crossmatch not pre detectable.
 Can occur upto 4 weeks after transfusion.
CLINICAL PICTURE:
 Falling Hb
 Hyprbillirubinemia
 Spherocytes on peripheral smear
 Low grade fever

16.  Extremely Rare.
 Occurs in Immunocompromised
individuals with identical HLA haplotypes.
 Donor lymphocytes are engrafted by the
recipient which attack the recipient’s
tissues considering them foreign.
 TA-GvHD can develop four to thirty days
after the transfusion.
 Bone marrow Aplasia is common cause of
death.

17. CLINICAL PRESENTATION:
Skin: Erythroderma, Swollen, Bullae
formation(most common)
GIT: Diarrhoea, Abdominal cramps
LIVER: Elevated LFTs, Hyperbillirubinemia
HEME: Bone marrow aplasia, Thrombocytopenia
persistent
Only supportive treatment is given in GVHD. It
can be prevented by giving Gamma-irradiated
blood to those at risk.

18.  Occurs during or 6hrs after transfusion.
 Can cause ARDS
 Can cause Non-Cardiogenic Pulmonary
edema
 It is explained by 2-Hit hypothesis
 All bllood products can cause it

20. 2-HIT HYPOTHESIS:
 1st hit is pulmonary pathology causing
localisation of neutrophils
 2nd hit is transfusion of blood products with
sensitized neutrophils
CLINICAL PRESENTATION:
 Hypoxemia (acute respiratory distress)
 Fever
 Tachycardia
 Tachypnoea

21.  CXR shows bilateral pulmonary infiltrates with
normal cardiac size.
CRITERIA OF DIAGNOSIS:
 No acute injury prior to transfusion
 No relation to risk factor for lung injury
 Bilateral pulmonary infiltrates on CXR
 No circulatory overload, PA
pressure<18mmhg
 Oxygen saturation<90%

23. MANAGEMENT:
 Follow General Guidelines
 Supportive therapy
 Diurectics has no role and can worsen the
condition
 Majority of patients may require mechanical
ventilation
 Notify Blood Bank for the error