1. TRANSFUSION REACTIONS

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. TRANSFUSION-RELATED ACUTE LUNG INJURY

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

10. 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

11. 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