The document discusses the critical aspects of blood transfusion reactions, including types and management strategies for both immune-mediated and non-immune mediated reactions. It details specific conditions such as febrile non-hemolytic, acute hemolytic, delayed hemolytic, transfusion associated lung injury (TRALI), and graft-versus-host disease (GVHD), emphasizing their symptoms, diagnosis, and required emergency interventions. Recommendations for clinical management highlight the necessity of immediate action, monitoring, and supportive treatments in the case of transfusion complications.

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