FEBRILE NONHEMOLYTIC TRANSFUSION REACTIONS ACUTE HEMOLYTIC TRANSFUSION REACTIONS DELAYED HEMOLYTIC TRANSFUSION REACTIONS ANAPHYLACTIC TRANSFUSION REACTIONS URTICARIAL TRANSFUSION REACTIONS TRANSFUSION-RELATED ACUTE LUNG INJURY POSTTRANSFUSION PURPURA

-Urticarial transfusion reactions The major immunologic reaction transfusion -Febrile nonhemolytic transfusion reactions -Acute hemolytic transfusion reactions -Delayed hemolytic transfusion reactions -Anaphylactic transfusion reactions -Urticarial transfusion reactions -Transfusion-related acute lung injury -Post transfusion purpura -graft-versus-host disease

Transfusion Management The management of FNHTRs consists of the following steps: -Stopping the transfusion and determining that a hemolytic reaction is not taking place . - Administration of antipyretics (aspirin should be avoided in thrombocytopenic patients) . moderate doses of meperidine in patients with severe chills and rigors.

ACUTE HEMOLYTIC TRANSFUSION REACTIONS : They are usually due to ABO incompatibility presenting triad of fever, flank pain, and red or brown urine . Fever and chills in patients under anesthesia or in coma, DIC may be the presenting mode, with oozing from puncture sites and hemoglobinuria. , fever is also the presenting sign of a "benign" FNHTR. -Stop the transfusion, but leave intravenous line attached  -b Begin an infusion of normal saline (not Ringer's or dextrose) - From the other arm, obtain a sample for a direct antiglobulin test and for plasma free hemoglobin - Save a urine sample for hemoglobin testing, alert the blood bank, and check for clerical error

-Febrile nonhemolytic transfusion reactions The major immunologic reaction to blood Transfusion are: -Febrile nonhemolytic transfusion reactions -Acute hemolytic transfusion reactions -Delayed hemolytic transfusion reactions -Anaphylactic transfusion reactions -Urticarial transfusion reactions -Transfusion-related acute lung injury -Posttransfusion purpura -Graft-versus-host disease

Treatment of acute reaction: hypotension, and pink plasma or urine that an AHTR is possible, generous fluid replacement with saline (100 to 200 mL/h) to support a urine output above 100 mL/h should be initiated while lab tests are awaited in an attempt to prevent the development of acute renal failure. The beneficial effect of urinary alkalinization in patients with marked hemoglobinuria is uncertain.

Delayed hemolytic transfusion reactions (DHTRs) are due to an anamnestic antibody response occurring after reexposure to a foreign red cell antigen previously, transplantation, or pregnancy. The antibody, often of the Kidd or Rh system, is undetectable on pretransfusion testing, but increases rapidly in titer following the transfusion.

ANAPHYLACTIC TRANSFUSION REACTIONS Rapid onset of anaphylaxis, manifested by shock, hypotension, angioedema, and respiratory distress, An anaphylactic transfusion reaction (ATR) may occur within a few seconds to a few minutes following the initiation such as frozen or liquid plasma, red cells, platelets, granulocytes, cryoprecipitate, or gamma globulin; They are not generally seen following the administration of normal serum albumin, plasma protein fraction, or coagulation factors. It is the rapid onset that is characteristic of an ATR.

Discomfort Anemia Acute kidney failure Shock Lung disfunction Complications of Immune Reaction    Discomfort Anemia Acute kidney failure Shock Lung disfunction

Treatment of ATR Treatment ATR consists of the following steps:  -Immediate cessation of the transfusion  -Epinephrine, 0.3 mL of a 1:1000 im -solution  Preparation, for possible administration, - intravenous epinephrine drip  -Airway maintenance, oxygenation  -Volume maintenance with saline  -Vasopressors (eg, dopamine), if necessary Prevention consists of establishing the diagnosis after the fact and using either IgA-deficient blood products, which can be obtained through large, regional blood centers, or "ultra-washed" red cell or pl

Heart rate (beats/min) = 116 - 4.0 x Hgb (g/dL) Heart rate was found to increase linearly in response to the acute isovolemic anemia, and could be described by the following formula: Heart rate (beats/min) = 116  -  4.0 x Hgb (g/dL)

Tests of reaction: RBC count Hemoglobin; serum Hemoglobin Hematocrit Haptoglobin Fibrin degradation products Coombs' test, indirect Coombs' test, direct CBC Bilirubin

Symptoms Fever Chills Rash Flank pain or back pain Bloody urine Fainting or dizziness

leukoreduction to eliminate leukocyte debris and leukocyte-generated cytokines would be performed on all cellular components intended for transfusion. This policy cannot currently be implemented because of cost considerations. At present the following patients should receive leukoreduced blood components:     Chronically transfused patients  Potential transplant recipients  Patients with previous febrile nonhemolytic transfusion reactions  CMV seronegative at-risk patients for whom seronegative components are not available

Washed red cells : In order to prevent or eliminate complications associated with infusion of proteins present in the small amount of residual plasma in red cell concentrates, the unit of blood can be washed immediately before infusion. This approach is indicated for the following conditions:     Patients with severe or recurrent allergic reactions (eg, hives) associated with red cell transfusion     Certain patients with IgA deficiency when IgA deficient donors are not available (although frozen deglycerolized red cells may be the component of choice; see below); patients with IgA deficiency may have circulating anti-IgA antibodies that react with IgA in the donor plasma In patients with T-activated red cells  In the rare patient with a complement-dependent autoimmune hemolytic anemia to prevent complement infusion.

Irradiated red cells In order to avoid the occurrence of graft-versus-host disease (GVHD) in patients who have hereditary immune deficiency states, transfused red cells must be subjected to irradiation with at least 2500 Gy to prevent the donor T lymphocytes from dividing in the recipient. Irradiation to prevent GVHD is also recommended for red cells collected from relatives entered in directed donation programs.