Main Transfusion Rxns

Main Transfusion Reaction Types

• Allergic

• Anaphylactic

• Febrile Non Hemolytic Transfusion Reaction

• Acute Hemolytic Transfusion Reaction

• Delayed Hemolytic Transfusion Reaction

• TRALI

• TACO

• GVHD

Allergic - Cause

Donor proteins act as allergens → bind to pre-formed recipient IgE → mast cell/basophil activation → histamine release → allergic symptoms (rash to anaphylaxis)

Allergic Rxn Symptoms

may include rash, itching, hives

Anaphylactic Causes

IgA-deficient recipient developing anti-IgA

• If these pts receive a transfusion containing normal donor IgA, their immune system recognizes it as foreign

  • Cannot be predicted w/ routine testing

  • Occurs very rarely

Anaphylactic Symptoms

Rapid onset: Hypotension, bronchospasm, shock

• Dyspnea, cyanosis, fever, hives

• must transfuse IgA-deficient products, washed products for prevention

  • Washed products remove donor plasma protein (IgA gone)

• Can occur within minutes

Febrile Non Hemolytic Cause

HLA antibody in recipient to donor leukocyte Ags

• cytokines in blood products containing WBCs and PLTS stimulates recipient’s immune system

  • Accumulate in storage

• Prevent using leukoreduction

Febrile Non Hemolytic Symptoms

Fever ≥38 °C, chills, rigors, back pain

• Normal Lab

• Within 4 hrs of transfusion

• Occurrence

  • Common in patients with multiple pregnancies and transfusions

    • Multiple exposures to HLA Ag

  • Common in women

  •  1:200 donor units transfused

Acute Hemolytic Cause

ABO mismatch (or medications, autoimmune disorders, thalasemmia/SC)

• by clerical error (most common0, wrong unit to wrong patient

• Severe sudden hypotension (SBP <70-60 mmHg)

• Resolves when transfusion stops

Acute Hemolytic Symptom

Fever, flank pain, DIC, hemoglobinuria

• Flushing, anxiety, lightheadedness

• Labs: ↓haptoglobin, ↑LDH, ↑bilirubin, positive DAT

• Kidney Failure!

• Onset: within minutes

Delayed Hemolytic Cause

Alloantibody (Kidd, Duffy, Kell) from previous transfusion or pregnancy

• Kidd Ab are notorious for causing DHTR because they can fall below detection in screens, but rapidly rise with re-exposure

Delayed Hemolytic Symptoms

• Days-weeks later

• extravascular hemolysis

• DAT positive, inadequate hgb rise

TRALI cause

Donor anti-HLA/neutrophil Abs react with recipient leukocytes

• Women donors of child bearing age not allowed

TRALI symptoms

NON-CARDIOGENIC pulmonary edema

• Hypotension

• Sudden-Onset

  • Symptoms ≤6 hrs post-transfusion: hypoxemia

TACO cause

too much blood in pts vascular system, caused by transfusing a unit too fast

• most often occurs in children and elderly pts

• can be fatal

TACO Symptoms

Hypertension, pulmonary edema, ↑BNP

• Dyspnea, orthopnea, cyanosis, rales, tachycardia

• sudden-onset - within 6 hrs

GVHD Cause

Transfused T cells react against recipient, rare occurrence

• Even just one can compromise weak immuno pt, unable to locate 

GVHD Symptoms

3–30 days posttransfusion, fever, erythematous maculopapular rash, abnormal liver function 

• Sequelae: Sepsis, hemorrhage, 90% mortality rate

Intravascular Hemolysis

• Primarily caused by IgM antibodies

• IgM efficiently activates complement system

• Leads to direct lysis of RBCs within blood vessels

• Common IgM antibodies: Lewis (Le), I (I), P (P1, anti-P1), MNS (MN)

Extravascular Hemolysis

• Mainly mediated by IgG antibodies

• IgG coats RBCs → marks them for destruction

• Clearance occurs via macrophages in spleen and liver

• Common IgG antibodies: Rh, Kell (K), Duffy (Fy), Kidd (Jk), Lutheran (Lub), MNS (Ss)

Note: Lutheran Lua = IgM (not usually clinically significant), Lub = IgG

TRALI vs TACO

TACO (Circulatory Overload)	Hypertension, pulmonary edema, JVD, ↑BNP, dyspnea	Cardiogenic cause → ↑BNP, hypertension → improves with diuretics
TRALI (Acute Lung Injury)	Dyspnea, hypoxemia, bilateral infiltrates ≤6 hrs	Normal BNP → no hypertension → donor anti-HLA/neutrophil Abs implicated

Intravascular Hemolysis

• Primarily caused by IgM antibodies

• IgM efficiently activates complement system

• Leads to direct lysis of RBCs within blood vessels

Common IgM antibodies: Lewis (Le), I (I), P (P1, anti-P1), MNS (MN), Lutheran (Lua)

Extravascular Hemolysis

• Mainly mediated by IgG antibodies

• IgG coats RBCs → marks them for destruction

• Common IgG antibodies: Rh, Kell (K), Duffy (Fy), Kidd (Jk), Lutheran (Lub), MNS (Ss)