Blood Transfusion Reaction

What are the different types of blood transfusion reactions?

• Allergic

• Febrile

• Hemolytic

• Lung injury (TRALI - transfusion related acute lung injury)

• TACO (Transfusion acute circulator overload)

Type 1 hypersensitivity plasma proteins in blood are the culprit

Allergic (can be anaphylactic)

What are symptoms of allergic blood transfusion reaction?

itching, bronchospasm, hives, cyanosis, shock, anxiety, stridor 

What is the timing of allergic reactions to blood transfusion?

within 2-3 hours - not immediate 

How to treat allergic reaction to blood transfusion?

First line of defense is epinephrine

• Antihistamines

• bronchodilators

• steroids

• CPR

Type II hypersensitivity Host antibodies react against donor WBCs

febrile

What are symptoms of febrile blood transfusion reactions?

flushing, headaches, chills, rigors 

What is the timing of the febrile reaction?

1-6 hours

How do you treat febrile reaction?

Tylenol and Benadryl are first line of defense

• demerol

• may be started on a reduced rate and premedicated prior to next infusion

Type II hypersensitivity; Incompatible ABO blood or RH factor. Will have hemolysis (destruction of RBCs) - most serious

Hemolytic

What are symptoms of hemolytic blood transfusion reaction? 

• flank pain (back pain)

• dyspnea

• shock

• increase HR

• increase RR

• sense of doom

What is the timing of hemolytic reaction?

15 minutes - 1 hour

How do you treat hemolytic reaction?

• Immediately stop infusion

• Can give diuretics

• Start IV NS in a NEW line

• Treat shock and DIC if needed

• Fluid resuscitation

• CPR

When donor blood contains antibodies against the recipient’s neutrophil antigens 

TRALI (Transfusion related acute lung injury) 

What are symptoms of TRALI?

• respiratory distress

• respiratory failure

• hypoxia

• respiratory collapse

What is the timing of TRALI blood transfusion reaction?

1-6 hours

How to treat TRALI?

• recognize early

• oxygen

• raise HOB

• intubation

• full recovery usually in 96 hours

Occurs when blood is transfused too quickly especially in the aging adult

TACO - Transfusion Acute Circulator Overload

What are symptoms of TACO?

Edema, HTN, fluid excess, bounding pulse, jugular vein distention

What is the timing of TACO?

1-6 hours

How do you treat TACO blood transfusion reaction?

• oxygen

• diuretics

• giving lasix between units and slowing rate of units being administered

• measure Is and Os