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Major transfusion reactions (Acute Haemolytic transfusion rx (1:76000)…
Major transfusion reactions
Classification
Non immune
Acute (TACO, Bacterial contamination)
Delayed (Infection, Iron overload)
Immune
Delayed (Delayed haemolytic, post-tx purpurae, tx associated GVHD, TRIM)
Acute (acute haemolytic, febrile-non haemolytic, anaphylactic, TRALI)
Acute Haemolytic transfusion rx (1:76000)
Cause
ABO/Rh mismatch - antigen/Ab complex - haemolysis
Non ABO Abs as a result of immunisation from prev preg or transfusion
Features
Fever, chills, chest and flank pain, nausea (masked by anaesthesia)
Under GA, the only signs may be hypot, bleeding diathesis, haemoglobinuria
Complications: CVS collapse, RF, DIC, death
Management
Stop tx / call for help
Maintain IV access (do not flush line). Use a new IV line if req.
Check pt. ID with label
Maintain BP and urine o/p (>100ml/hr): IVF, Vasopressor, possible diuretics (mannitol/frusemide)
Urine alkalinisation with bicarb
Ix: FBE, UEC, coags, haemolysis screen, rpt.G+H, urine (Hb)
Notify blood bank
Return unused blood for repeat crossmatch
Febrile non-haemolytic reactions
Cause
Cytokine release from WBCs, especially after Plt transfusion
Clinical features
Isolated fever (<39), v. common (1%), if hypot or tachy suspect acute haemolytic reaction or bacterial contamination
Management
Stop infusion
Antipyretic (but avoid aspirin in thrombocytopoenic or paeds patients)
Exclude bacterial contamination or acute haemolytic transfusion reaction
Notify blood bank
Anaphylaxis
Cause
Transfusion of IgA to patients who are IgA deficient and have formed anti-IgA
Transfusing an allergen to a sensitised patient e.g. nuts consumed by donor
Prevention
Transfusions with washed RBCs from which donor IgA has been removed
TRALI (1:10000)
Csuse
Immune: HLA antibodies in the donor's plasma directed against the recipient's leukocyte antigen
Non-immune: reactive lipid products released from the membranes of the donor blood cells act as a trigger
With both mechanisms there is activation of neutrophils in the lungs - damage to lung capillaries
All blood components, esp. FFP
Clinical features
Non cardiogenic pulmonary oedema leading to resp failure < 6 hrs after transfusion
Leading cause of transfusion related mortality
Most recover in 96 hours
Management
Stop transfusion
Supportive measures (ANC, 02, ventilation if necessary)
Diuretics are not beneficial
Notify blood bank so blood components from the same donor can be quarantined
Test donor and recipient serum for HLA antibodies and perform HLA type on the recipient
Bacterial contamination
Cause
Platelets (stored at room temp (G +ve most common)
Previously frozen components thawed by immersion in water bath
RBC components stored for several weeks (Yersinia enterocolitica most common)
Management
Stop transfusion
Culture patient and remainder of the blood component
Broad-spectrum Abx
Notify blood bank so blood components from the same donor can be quarantined