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TRANSFUSION REACTIONS

TRANSFUSION REACTIONS. 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

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TRANSFUSION REACTIONS

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  1. TRANSFUSION REACTIONS

  2. 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

  3. 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

  4. 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 IMMEDIATE HEMOLYTIC TRANSFUSION REACTION

  5. 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 DELAYED HEMOLYTIC TRANSFUSION REACTION

  6. 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 FEBRILE, NONHEMOLYTIC TRANSFUSION REACTION

  7. 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 (TRALI)

  8. TRANSFUSION-RELATED ACUTE LUNG INJURY

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

  10. 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 OTHER ACUTE NON-INFECTIOUS COMPLICATIONS OF TRANSFUSION

  11. Transfusion-related deaths 2005-2010 • TRALI – Transfusion-associated lung injury • TACO – Transfusion-associated circulatory overload • HTR – Hemolytic transfusion reaction

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