Transfusion Reactions

Adverse transfusion reaction

An undesirable response or effect in a patient temporarily associated with the administration of blood or blood components.

National Healthcare Safety Network (NHSN)

An organization that, in association with AABB and the CDC, monitors and tracks transfusion reactions.

Top five causes of transfusion-associated fatalities

1. TRALI (Transfusion Related Lung Injury) = 38%

2. TACO (Transfusion Associated Circulatory Overload) = 24%

3. Non-ABO hemolytic transfusion reaction = 15%

4. Microbial infections = 10%

5. ABO hemolytic transfusion reaction = 7%

6. Anaphylactic reactions = 5%

Clinical features that may be present in patients who are having an adverse transfusion reaction

• Fever ≥1°C increase or > 38°C

• Chills and rigors

• Signs of respiratory distress (wheezing, coughing, cyanosis, or dyspnea)

• Hypertension or hypotension

• Pain: abdominal, chest, flank or back, infusion site

• Skin manifestations: urticarial, rash, flushing, edema

• Jaundice or hemoglobinuria

• Nausea or vomiting

• Abnormal bleeding

• Oliguria or anuria

• Decreased H&H with spherocytes.

Acute Hemolytic Transfusion Reaction (AHTR)

Happens immediately and upon first exposure to incompatible units. Typically due to an ABO incompatibility, but can be due to other preformed antibodies with a significant titer. Incidence is 1:50K transfusions.

Most common signs and symptoms of an Acute Hemolytic Transfusion Reaction

• Fever with or without chills

• Hemoglobinuria

Delayed Hemolytic Transfusion Reaction

Antibodies are directed to RBC antigens and bind to RBC membrane, but complement is not initiated or complete. Patients present with fever and anemia days to weeks after transfusion. Other possible symptoms: jaundice, leukocytosis, and hemoglobinuria.

Often unrecognized and go unreported. They occur more frequently than acute hemolytic transfusion reactions. They also tend to be less severe, and often seen in multiply transfused patients (sickle cell, thalassemia).

List three causes of non-immune RBC destruction

• Patient has an underlying hemolytic disorder

• Inadequate deglycerolization after freezing

• Physical damage to donor RBCs:

  • Overheating

  • Incompatible fluids being infused at the same time

  • Excessive pressure/infusion rate

  • Bacterial contamination

Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

Presenting features may be similar to AHTR (must rule out AHTR).

Causes the following in the patient:

• An increase in temperature

• No hemolysis

• Negative DAT

May be caused by:

• Transfused cytokines

• Cytokine release from the recipient in response to transfused WBC

• Antibodies targeted at transfused WBC

Prevented by using leukoreduced units (use a leukoreduction filter)

Transfusion Associated Allergic (urticarial and anaphylactic) Reaction

Caused by factors present in the donor PLASMA

Urticarial:

• Classic IgE-mediated hypersensitivity to an allergen in the donor plasma

• Mast cell activation causes urticaria (hives) and pruritus (itching)

Anaphylactic:

• Non-IgE-mediated mast cell degranulation

  • Typically an anti-IgA binding to donor IgA in recipients who are IgA deficient

• Manifestations begin with GI issues followed by urticaria, angioedema, hypotension, and eventually shock.

• Life threatening and must be treated with epinephrine while maintaining airway and assure appropriate blood pressure.