Acute transfusion reaction: Difference between revisions

No edit summary
 
(44 intermediate revisions by 7 users not shown)
Line 1: Line 1:
==Background==
==Background==
*For all reactions:
*If concern for fluid overload, may need to transfuse as split pRBCs to tranfuse as slow as 1mL/kg/hr
**1. Stop the transfusion (at least temporaily)
*Sepsis is most commonly due to [[yersinia]], which is able to grow easily in refrigerated blood
**2. Call the blood bank
 
**3. Draw a new type + screen
{{Transfusion risk}}
 
==Clinical Features==
*Etiology specific, see ddx below
 
==Differential Diagnosis==
{{Transfusion reaction types}}


== Acute ==
{{Acute Allergic DDX}}
#Intravascular Hemolytic Tranfusion Reaction
##Occurs due to ABO incompatibility
##Diagnosis
###Back pain, headache, hypotension, dyspnea, pulmonary edema, bleeding, renal failure
###Labs c/w hemolysis
##Treatment
###Stop transfusion
####Risk of death is proportional to amount of incompatible blood received
###Maintain urine output with IVF, mannitol, and furosemide as needed
###Treat shock with volume and vasopressors
###Treat coagulopathy w/ FFP
#Febrile Nonhemolytic Tranfusion Reaction
##Occurs in 20% of pts due to recipient Ab against donor leukocytes
##Diagnosis
###Fever, HA, myalgias, tachycardia, dyspnea, chest pain
##Treatment
###Stop tranfusion pending rule-out of hemolytic transfusion reaction
###Give antipyretic
###Restart transfusion once hemolytic transfusion reaction is ruled-out
#Allergic Tranfusion Reaction
##Occurs due to immune response to plasma proteins
##Diagnosis
###Symptoms range from urticaria/pruritus to bronchospasm, wheezing, anaphylaxis (rare)
##Treatment
###Stop transfusion until able to evaluate severity of allergic reaction
###Give diphenhydramine
###Restart transfusion if symptoms are mild
#Transfusion-Related Acute Lung Injury (TRALI)
##Due to granulocyte recruitment and degranulation within the lung
##More common with FFP and plt tranfusions (extremely rare with pRBC transfusion alone)
##Diagnosis
###ARDS-like symptoms
###B/l pulmonary infiltrates due to noncardiogenic pulmonary edema w/in 6h of transfusion
##Treatment
###Strop transfusion
###Treat like ARDS
###Avoid diuresis
#Fluid Overload
##Split pRBCs to tranfuse more slowly (as slow as 1mL/kg/hr)
#Sepsis
##Most commonly due to yersinia which is able to grow easily in refrigerated blood


== Delayed ==
==Evaluation==
#Extravascular Hemolytic Tranfusion Reaction
*Workup of hemolytic reaction
##Occurs days to weeks after transfusion
**CBC with microscopy differential
##Hemolysis occurs in spleen, liver, and bone marrow
**Formal urinalysis with bilirubin
##Diagnosis
**Haptoglobin, LDH, free hemoglobin
###Hyperbilirubinemia
**Serum total and direct bilirubin
###Poor response to transfusion
**Coombs test of pre-transfusion and post-transfusion blood
##Treatment
[[File:Coombs.png|thumbnail]]
###None necessary; rarely fatal
*Consider CXR to help differentiate anaphylaxis, TRALI, TACO
#Graft-vs-Host
{{TRALI vs TACO}}
##Occurs in leukemia/lymphoma or immunocompromised
##Diagnosis
###Fever, rash, N/V
###LFT abnormalities, pancytopenia
##Treatment
###Glucocorticoids
#Hemosiderosis


== Transfusion Risk Ratios ==
==Management==
*For all reactions:
**Stop the transfusion (at least temporarily)
**Call the blood bank
**Draw a new type + screen


#1:10 Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
==Disposition==
#1:100 Minor allergic reactions (urticaria)
#1:300 Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
#1:700 Transfusion-associated circulatory overload per transfusion  episode
#1:5000 Transfusion-related acute lung injury (TRALI)
#1:7000 Delayed hemolytic transfusion reaction
#1:10,000 Symptomatic bacterial sepsis per pool of 5 donor units of platelets
#1:40,000 Death from bacterial sepsis per pool of 5 donor units of platelets
#1:40,000 ABO-incompatible transfusion per RBC transfusion episode
#1:40,000 Serious allergic reaction per unit of component
#1: 82,000 Transmission of hepatitis B virus per unit of component
#1:100,000 Symptomatic bacterial sepsis per unit of RBC
#1:500,000 Death from bacterial sepsis per unit of RBC
#1:1,000,000 Transmission of West Nile Virus
#1:3,000,000 Transmission of HTLV per unit of component
#1:3,100,000 Transmission of hepatitis C virus per unit of component
#1:4,700,000 Transmission of HIV per unit of component


==See Also==
{{Transfusion reactions see also}}


== Source  ==
==References==
#2/18/06 DONALDSON (adapted from Rosen)
<references/>
#Canadian Blood Services (Public Health Agency of Canada)


[[Category:Heme/Onc]]
[[Category:Heme/Onc]]

Latest revision as of 14:25, 19 September 2017

Background

  • If concern for fluid overload, may need to transfuse as split pRBCs to tranfuse as slow as 1mL/kg/hr
  • Sepsis is most commonly due to yersinia, which is able to grow easily in refrigerated blood

Transfusion Risk Ratios[1]

Rate Complication
1:10 Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
1:100 Minor allergic reactions (urticaria)
1:300 Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
1:700 Transfusion-associated circulatory overload per transfusion episode
1:5,000 Transfusion-related acute lung injury (TRALI)
1:7,000 Delayed hemolytic transfusion reaction
1:10,000 Symptomatic bacterial sepsis per pool of 5 donor units of platelets
1:40,000 Death from bacterial sepsis per pool of 5 donor units of platelets
1:40,000 ABO-incompatible transfusion per RBC transfusion episode
1:40,000 Serious allergic reaction per unit of component
1:82,000 Transmission of hepatitis B virus per unit of component
1:100,000 Symptomatic bacterial sepsis per unit of RBC
1:500,000 Death from bacterial sepsis per unit of RBC
1:1,000,000 Transmission of West Nile Virus
1:3,000,000 Transmission of HTLV per unit of component
1:3,100,000 Transmission of hepatitis C virus per unit of component
1:4,700,000 Transmission of HIV per unit of component

Clinical Features

  • Etiology specific, see ddx below

Differential Diagnosis

Transfusion Reaction Types

Acute allergic reaction

Evaluation

  • Workup of hemolytic reaction
    • CBC with microscopy differential
    • Formal urinalysis with bilirubin
    • Haptoglobin, LDH, free hemoglobin
    • Serum total and direct bilirubin
    • Coombs test of pre-transfusion and post-transfusion blood
Coombs.png
  • Consider CXR to help differentiate anaphylaxis, TRALI, TACO

TRALI vs TACO

TRALI TACO
Onset Acute, within 6hrs Often more gradual
BP Low High
Temp Febrile Normal
JVD/pedal edema Unlikely Likely
CVP/PAWP Normal Elevated
BNP Normal Elevated
Resp Dyspneic Dyspneic
CXR B/l infiltrates B/l infiltrates

Management

  • For all reactions:
    • Stop the transfusion (at least temporarily)
    • Call the blood bank
    • Draw a new type + screen

Disposition

See Also

References

  1. ↑ Wagner, L. Why Should Clinicians Be Concerned about Blood Conservation? ITACCS. 2005 PDF
Retrieved from "https://www.wikem.org/w/index.php?title=Acute_transfusion_reaction&oldid=156358"