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.