Acute transfusion reactions can be immunologic or non-immunologic. Immunologic reactions include acute hemolytic reactions caused by improper blood typing which can lead to fever, shock, and organ damage. Febrile non-hemolytic reactions are caused by donor white blood cells releasing cytokines in response to recipient antibodies, while bacterial sepsis is a rapid onset reaction to contaminated blood products. TRALI is a lung injury caused by donor antibodies attacking recipient white blood cells in the lungs. Acute reactions must be promptly recognized and treated by stopping the transfusion and providing supportive care.

1. Acute Transfusion Reactions Dr Omar Chughtai MBBS, MD, FCAP

2. Transfusion Reactions Immunologic Acute hemolytic reactions Delayed hemolytic reactions Febrile nonhemolytic reactions Allergic reactions Transfusion purpura Non-Immunologic Infections Volume overload Lung injury Hypothermia Coagulopathy.

3. Acute Transfusion Reactions Febrile Acute Hemolytic Febrile non-hemolytic Bacterial sepsis TRALI Afebrile Allergic reaction Anaphylaxis

4. Acute Hemolytic Reaction Destruction of donor red cells by preformed recipient antibodies Improper typing and crossmatching Clerical error

5. Acute Hemolytic Reaction Fever and Chills Hypotension rapidly leading to shock Back pain Chest tightness Bleeding at transfusion site Hemoglobinemia, Hemoglobinuria Activation of coagulation cascade, leading to DIC Selective renal vasoconstriction, leading to ATN

6. Acute Hemolytic Reaction STOP the transfusion! Patient survival is directly affected by volume of incompatible blood transfused Maintain IV access Run normal saline to give volume support

7. Investigation Clerical check Proper patient Proper unit Check for hemolysis: Visible Hb check DAT Serum bilirubin rises Serum haptoglobin falls

8. Febrile Non-Hemolytic Reaction Fever and Chills 1C or 2F rise in temperature Patient has anti-HLA antibodies against donor white cells Donor and patient white cells release pyrogenic cytokines

9. Febrile Non-Hemolytic Reaction Can be prevented by pre-storage leukocyte reduction Less white cells in transfused unit Management: Stop the transfusion Investigate for hemolysis Pre-transfusion Acetaminophen

10. Bacterial Sepsis Red Cells: Pseudomonas Citrobacter E coli Platelets: Staph Strep

11. Bacterial Sepsis Rapid onset high fever Fever up to 105F within 15 minutes Rigors Vomiting Diarrhea Shock

12. Bacterial Sepsis Management: Stop the transfusion IV Antibiotics IV Fluids Culture blood unit Interview the donor

13. TRALI Transfusion Related Acute Lung Injury Non-cardiogenic pulmonary edema Respiratory distress, Fever During or soon after transfusion Looks like ARDS

14. TRALI More often seen with plasma products Donor Anti-HLA and Anti-NeutrophilAb’s attack patient’s white cells White cell aggregates in pulmonary vasculature Pulmonary edema even though there is no volume overload

15. TRALI Management: Respiratory support Steroids No diuretics Patients usually recover in 24 hours Donor should be tested for Anti-HLA and Anti-Neutrophil Antibodies

16. Acute Allergic Reaction Afebrile Itching, commonly at infusion site Sneezing Management: Stop Observe Anti-histamine Resume slowly

17. Anaphylaxis Afebrile Catastrophic allergic response with first few drops of blood Acute systemic crash Hypotension Respiratory distress Shock

18. Anaphylaxis Management: Stop the transfusion Epinephrine IV Fluids

19. Acute Crash Acute Hemolytic Transfusion Reaction Bacterial Sepsis Anaphylaxis