Transfusion Reactions Joy

7/27/2019 Transfusion Reactions Joy

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The Resident on Duty decided totransfuse the patient with 2 units ofpacked red blood cells (PRBCs)


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PRBC


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Immune-Mediated Reactions

Acute Hemolytic Transfusion Reactions

preformed antibodies that lyse donorerythrocytes.

The ABO isoagglutinins are responsible

for the majority of these reactions

Acute hemolytic reactions may present

hypotension

tachypnea

tachycardia

Fever chills

hemoglobinemia

hemoglobinuria

chest and/or flank pain

discomfort at the infusion site

Errors at the patient's bedside, such asmislabeling the sample or transfusing

the wrong patient


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AnaphylacticReaction

immediate hypersensitivitytype of immune system

response

mild urticaria (hives) and

pruritus to severe shock anddeath

Symptoms and signs includedifficulty breathing,

coughing, nausea and

vomiting, hypotension,bronchospasm, loss of

consciousness, respiratoryarrest, and shock

IgA deficiency


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Febrile Nonhemolytic Transfusion

Reaction (FNHTR)

FNTHR

most frequent reaction associated with thetransfusion of cellular blood components

characterized by chills and rigors and a 1C rise intemperature.

The leukocyte antibodies are commonly directedagainst antigens present on monocytes,

granulocytes,or lymphocytes

diagnosed when other causesof fever in the transfused

patient are ruled out.

Antibodies directed against donor leukocyte andHLA antigens may mediate these reactions

American Association of Blood Banks(AABB)Technical Manualdefines FNHTR as a 1C

temperature rise associated with transfusion andhaving no medical explanation other than blood

component transfusion


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acute respiratory distress,either during or within 6 h

of transfusing the patient. characterized by chills,

cough, fever, cyanosis,hypotension, andincreasing respiratory

distress shortly aftertransfusion of bloodcomponent volumes thatusually do not producehypervolemia

leukocyte antibodies indonor or patient plasma

Transfusion-

RelatedAcute Lung

Injury


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Nonimmunologic Reactions

fever and chills,which can progress toseptic shock and DIC.

(CDC), most arecaused by bloodcomponentscontaminated byYersinia enterocolitica

BacterialContamination

Reactions appear rapidly during

transfusion or withinabout 30 minutesafter transfusion

this type of reactionis termed warm andis characterized bydryness and flushingof the patients skin

Clinical signsand symptoms


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(transfusion-associated circulatory

overload, TACO) Blood components are excellent volume

expanders

-> Fluid overload

iatrogenic (physician-caused) transfusion

reaction. congestive heart failure and pulmonary

edema

dyspnea, coughing, cyanosis, orthopnea,chest discomfort, headache, restlessness,tachycardia, systolic hypertension (greaterthan 50mmHg increase), and abnormalelectrocardiogram results.

FluidOverload


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Electrolyte Toxicity

RBC leakage during storage increases theconcentration of potassium in the unit.

Citrate, commonly used to anticoagulateblood components

Hypocalcemia

manifested by circumoral numbness and/ortingling sensation of the fingers and toes,may result from multiple rapid transfusions.


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Hypothermia

Refrigerated(4C) or frozen (18C or below)

bloodcomponents

rapidly infused

Cardiacdysrhythmias

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Transfusion Reactions Joy