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Blood Transfusion Reactions (Anaphylaxis (within 24 hr) (Occurs when an…
Blood Transfusion Reactions
Acute Haemolytic reaction e.g. ABO incompatibility ( within 24 hours)
Incompatible RBCs attacked by patients anti-A or anti-B. Complement pathway is activated --> intravascular haemolysis --> can progress to DIC, shock and renal failure
Symptoms include agitation, rapid onset of increased temperature, hypotension, oozing venepuncture sites, abdominal/ chest pain
Management - STOP transfusion, DIC is treated with FFP, cryoprecipitate, prothrombin complex concentrate. Monitor urine output, fluid replacement
Anaphylaxis (within 24 hr)
Occurs when an individual has been previously sensitised to an allergen present in the donor blood and on re-exposure , releases IgE or IgG antibodies
Symptoms include bronchospasm, cyanosis, hypotension, soft tissue swelling
Management - STOP transfusion, maintain airways, Oxygen, adrenaline IM every 10 mins, antihistamines, salbutamol ( for airways)
To a lesser extext allergic reactions can occur, with symtpoms such as urticaria and itching. SLOW or STOP transfusion + give chlorphenamine slowly IV / IM
Infective shock (within 24 hours)
Bacterial contamination of the blood component is rare. Most common in platelets due to them being stored at 22 degrees
Symptoms may include rapid fever, hypotension, rigors
Management - STOP transfusion, Blood cultures, start broad spec antibiotics
TACO - transfusion associated circulatory overload
Respiratory distress, orthopnoea, cyanosis, tachycardia, hypertension, rales on auscultation, raised JVP, S3 on cardiac auscultation. CXR = cardiomegaly, interstitial infiltrates
STOP transfusion, resp support, diuretics
TRALI - Transfusion associated lung injury
Respiratory distress, hypoxemia, rales on auscultation, hypotension, fever, transient leukopenia CXR = diffuse bilateral infiltrates
Due to neutrophil mediated damage to the pulmonary microvasculature
Resp support, can be fatal
Fluid overload (within 24 hr)
Too much fluid too quickly --> pulmonary oedema + acute respiratory failure.
Dyspnoea, hypoxia, tachycardia, increased JVP, basal crepitations
SLOW or STOP transfusion, oxygen, diuretics
Delayed ractions (after 24 hours)
Graft versus host disease- rare complication. Caused by T-lymphocytes in donor component immunologcally attacking recipient. often fatal
Iron overload - for long term transfusions. iron deposits in liver and cardiac tissue
Infections - Hep B+C, HIV
Post transfusion purpura - fall in platelets. Requires IV Ig and platelet transfusion