Blood transfusion reactions

Name some potential complications of blood transfusions?

Acute haemolytic reaction

Non-haemolytic febrile

Allergic/anaphylaxis

Infective

Transfusion-Related Acute Lung Injury

Transfusion-Associated Circulatory Overload

Hyperkalaemia, iron overload, clotting

Peri-transfusion fever, chills - Dx, pathophysiology and Mx

Non-haemolytic febrile reaction

Antibodies reacting with white cell fragments in blood product and cytokines that have leaked from blood cell during storage

Slow/stop transfusion, paracetamol, monitor

Peri-transfusion pruritus, urticaria - Dx, pathophysiology and Mx

Minor allergic reaction

Foreign plasma proteins

Temporarily stop transfusion, antihistamine, monitor

Peri-transfusion hypotension, dyspnoea, wheezing, angioedema - Dx, pathophysiology and Mx

Anaphylaxis

Can be caused by pts with IgA deficiency who have anti IgA antibodies

Stop transfusion, IM adrenaline, ABCDE

Peri-transfusion fever, abdo pain, hypotension - Dx, pathophysiology and Mx

Acute haemolytic reaction

ABO-incompatible blood (human error), causing massive intravascular haemolysis due to RBC destruction by IgM antibodies

Stop transfusion, confirm diagnosis (check identity, direct Coombs test, repeat cross-match), ABCDE (IVF)

Peri-transfusion pulmonary oedema, hypertension - Dx, pathophysiology and Mx

Transfusion-Associated Circulatory Overload

Excessive rate of transfusion, pre-existing HF

Slow/stop transfusion, consider furosemide + O2

Peri-transfusion hypoxia, pulmonary infiltrates on CXR, fever, hypotension - Dx, pathophysiology, Mx

Transfusion-Related Acute Lung Injury

Non-cardiogenic pulmonary oedema, secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood

Stop transfusion, O2, ABCDE