7 Adverse Reactions To Transfusion.docx

7 Adverse Reactions To Transfusion No 1

Reaction Type Acute Hemolytic Reaction

Symptoms Fever, chills and fever, the feeling of heat along the vein in which the blood is being transfused, pain in the lumbar region, constricting pain in the chest, tachycardia, hypo-tension, and hemoglobinem ia with subsequent hemoglobinuria and hyperbilirubinemia. A "feeling of impending doom" is frequently reported by the patient as an early sign of this reaction.

Cause Frequency Human error Rare such as mislabeled pretransfusio n specimen; the transfusion of properly labeled blood to the wrong person, or clerical errors occurring within the Blood Bank transfused red cells react with circulating antibody in the recipient with resultant intravascular hemolysis

Most likely to occur In an unconscious or when a group O anesthe-tized patient is patient: Uncontrollable mistakenly bleeding due to transfused with group disseminated

Prevention proper identification of patients, pretransfusio n blood samples and blood components at the time of transfusion

intravascular coagulation may be the only sign of a hemolytic transfusion reaction

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Delayed Hemolytic Reaction

Notify the Blood Bank at the time the reaction is suspected, to allow prompt investigation. Care must be taken that subsequently transfused red cells lack the antigen corresponding to the patient's antibody.

the most common signs are a falling hematocrit (due to extravascular destruction of the transfused red blood cells) and a positive direct antiglobulin (Coombs) test (DAT).

A, B, or AB blood. Patients receiving a major ABOincompatible marrow or stem cell transplant with sufficient red cell content will likely develop an acute hemolytic reaction Many Uncomon delayed hemolytic reactions will go undetected because the red cell destruction occurs slowly

Delayed hemolytic reactions "delayed" occur in hemolytic patients who reactions have commonly developed occurs about 4- antibodies 8 days after from blood previous transfusion, transfusion but may or pregnancy

develop up to one month later. There may also be hemoglobinuri a and a mild elevation of the serum bilirubin. . Symptomatic patients may manifest fever and leukocytosis thus appearing to have an occult infection.

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Febrile

fever or chill fever A temperature rise of 1.8 F or 1.0 C from the baseline

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Allergic urticaria

allergic reactions may be associated with laryngeal edema and bronchospasm. If coupled with another sign,

but, at the time of pretransfusio n testing, the antibody in question is too weak to be detected by standard procedures. Subsequent transfusion with red cells having the correspondin g antigen results in an anamnestic antibody response and hemolysis of transfused red cells. Cytokines and antibodies to leukocyte antigens reacting with leukocytes or leukocyte fragments this reaction is caused by foreign plasma proteins

1 in 8 transfusion s

1% of recipients

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Allergic Anaphylaxis

TRALI

such as fever, evaluation for a hemolytic reaction may be indicated. anaphylactic or may be due anaphylactoid to anti-IgA Respiratory involvement with dyspnea or stridor may be more pronounced than is usually seen in typical allergic reactions. Reactions manifest cardiovascular instability that includes hypotension, tachycardia, loss of consciousness, cardiac arrhythmia, shock and cardiac arrest. abrupt onset of noncardiogenic pulmonary edema Severe cases may require assisted ventilation with high FIO2.

TRALI has been associated with the presence of antibodies in the donor plasma reactive to recipient leukocyte

Rare

TRALI is a rare though under recognized complicatio n of transfusion

Most cases of TRALI resolve within 72 hours although fatalities may occur in approximatel y 10 percent of cases.

antigens or with the production of inflammator y mediators during storage of cellular blood components 7

Hypotension

A drop of at least 10 mm Hg in systolic or diastolic arterial blood pressure in the absence of signs or symptoms of other transfusion reactions if the immediate pretransfusion blood pressure is elevated from the patients typical blood pressure, and the arterial pressure does not fall below the patients usual blood pressure, it should not be considered a hypotensive reaction. The

onset of hypotension is during the transfusion, and resolves quickly with discontinuation of the transfusion. If hypotension persists beyond 30 minutes after discontinuing the transfusion, another diagnosis should be strongly considered. National Healthcare Safety Network Biovigilance Component. (2014). Hemovigilance Module Surveillance Protocol. http://www.cdc.gov/bloodsafety/basics.html Rudmann, S. (2005). Textbook of Blood Banking and Transfusion Medicine. Philadelphia: Elsevier Saunders