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Blood transfusion reactions

Hemolytic Reactions

Reaction

Response

Treatment

Acute Hemolytic Transfusion Reaction

Antibody reaction  + Complement fixation to rbc A, B, Kell, Kidd, Duffy and Ss antigens

Hemolysis, acute renal failure, hypotension, bronchospasm, DIC

Supportive measures: inotropes and vasopressors to prevent shock, maintain intravascular volume and urine output with IVF and diuretics

Delayed Hemolytic Reactions

 

Prior sensitization to donor antigens (kidd, kell, Rh) – low levels of antibodies over time such that they are not detected on routine screening. Transfusion exposure causes an anamnestic response.

Usually rbc destruction occurs extravascularly and symptoms are less severe than AHTR. Low grade fever, ↑ indirect bilirubin, jaundice, anemia

Supportive, hydration and transfusion of compatible rbc as necessary

 

 

 

Nonhemolytic reactions

 

 

 

Minor Allergic Reactions

Allergic reaction to donor plasma proteins

Rash, pruritus, swelling

Diphenhydramine, Steroids

Anaphylactic Reactions

Prior sensitization in a patient with IgA deficiency and subsequent exposure to IgA containing product

Dyspnea, bronchospasm, angioedema, hypotension

Steroids, epinephrine

Febrile reactions

Antibody reactions to donor leukocytes.

Typically >1◦C rise in temperature within 4 hours of transfusion plus chills, myalgia, nausea, non-productive cough, respiratory distress

Acetaminophen. Usually defervesce in 48 hours.

 

Transfusion-Related Acute Lung Injury (TRALI)

 

Anti- HLA antibodies in the donor interacts with recipients leukocytes causing aggregation in the pulmonary circulation

Fever, chills, non-cardiogenic pulmonary edema, bilateral pulmonary infiltrates and severe pulmonary insufficiency

Supportive. Usually resolves in 24-48 hours with supportive care

Graft-Versus-Host Disease (GVHD)

Donor lymphocytes may not be rejected in immunosuppressed patients. They can proliferate and establish an immune response against the recipient. Typically with transfusion of cellular products, less with FFP and cryoprecipitate.

Rapid pancytopenia

Irradiation of blood products is the only proven preventive measure.

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