TRANSFUSION REACTIONS

IMMEDIATE HEMOLYTIC TRANSFUSION REACTION Intravascular lysis of transfused rbcs by complement, IgM Causes: Transfusion of ABO-incompatible blood Transfusion of ABO-incompatible plasma Non-ABO antibodies Clinical manifestations: Fever (but most febrile reactions not hemolytic) Back pain Dark or red urine (hemoglobinuria) Bronchospasm Shock DIC Organ failure (esp kidneys) Death

IMMEDIATE HEMOLYTIC TRANSFUSION REACTION Evaluation of suspected cases Check blood product/paperwork to ensure correct product given Notify blood bank/transfusion service Obtain blood and urine samples: Plasma and urine hemoglobin Direct Coombs test Repeat crossmatch/antibody screen Repeat ABO/Rh typing

IMMEDIATE HEMOLYTIC TRANSFUSION REACTION Management Stop transfusion immediately IV crystalloid or colloid Maintain BP, heart rate Maintain airway Diuresis fluid, loop diuretic (mannitol may cause volume overload) Monitor renal and coagulation status

DELAYED HEMOLYTIC TRANSFUSION REACTION IgG-mediated lysis of transfused red cells (usually extravascular, non-ABO) Usually begins 5-10 days after transfusion Jaundice, falling Hct, positive direct Coombs test, fever Not generally life-threatening

FEBRILE, NONHEMOLYTIC TRANSFUSION REACTION Cause: cytokines released by leukocytes during storage; antibodies to HLA antigens on transfused or donor PMNS Incidence: ≤0.5% of units transfused More common in multiply transfused recipients Fever, chills, respiratory distress in severe reactions Reduced incidence/severity with leukocyte-poor product

TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI) Hypoxemia with bilateral pulmonary infiltrates No increase in central venous or pulmonary artery pressures Usually begins acutely within 6 hours of transfusion Clinical: acute respiratory distress, fever, chills Pathophysiology: Underlying lung injury (eg, sepsis, pneumonia) causes PMNs to adhere to pulmonary capillaries Mediators in transfused blood product (neutrophil antibodies, cytokines) activate PMNs with resultant capillary injury

TRANSFUSION-RELATED ACUTE LUNG INJURY

TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI) Risk: FFP > platelets > RBC Treatment: stop transfusion (if still in progress); oxygen; ventilatory support if necessary; pulse corticosteroids

OTHER ACUTE NON-INFECTIOUS COMPLICATIONS OF TRANSFUSION Allergic reactions Anaphylaxis (IgA-deficient recipient) Lung damage from microaggregates (massive transfusion) Transfusion-associated circulatory overload (“TACO”) Bacterial infection (mainly with platelet transfusion) Hypothermia (rapid infusion of refrigerated blood) Citrate toxicity/hypocalcemia (massive transfusion or apheresis) Graft-vs-host disease Air embolism

Transfusion-related deaths 2005-2010 TRALI TACO HTR (non-ABO) (ABO) Bacterial Infection Anaphylaxis 2005 29 1 16 6 8 2006 35 9 3 7 2007 34 5 2 2008 10 2009 13 12 4 2010 18 TRALI – Transfusion-associated lung injury TACO – Transfusion-associated circulatory overload HTR – Hemolytic transfusion reaction