Transfusion Reactions

What is the cause of Immediate Hemolytic reactions?

Usually ABO incompatible units get transfused

How long does it take for an immediate hemolytic reaction to happen?

Usually 1-15 minutes after the transfusion

How can immediate hemolytic reactions be treated?

Supportive care to get BP and O2 up

What is the cause of febrile non-hemolytic reactions?

Usually due to cytokine presence from wbc breakdown or wbc antibodies in patient that reacts with donors (platelets)

How long does it take for FNH reaction to occur?

Usually 2-4 hrs from the start of transfusion

How can FNH be treated?

Acetominophen and ruling out other causes

What is the cause of Urticarial mild allergic reaction?

From IgE antibodies in the patient that is reacting with an allergen in donor plasma

How long does it take for allergic reaction to occur?

1-45 minutes from start of transfusion

How can mild allergic transfusion be treated>

Antihistamines

What is the cause of severe anaphylactic allergic reaction?

When recipient is IgA deficient and makes anti-IgA from previous transfusions and binds to donor IgA

How long does it take for severe allergic reaction to occur?

Within 1-15 minutes

What are symptoms of severe allergic reaction?

Urticaria, pruritis, low BP, hypoemia

How can severe allergic hemolytic reactions be treated?

Epinephrine, antihistamine, corticosteroids

What is the cause of bacteriogenic hemolytic reaction?

Usually due to bacteria in blood product from normal flora, transient bacteremia, product contamination, improper storage area

How long does it take for bacteriogenic to happen?

Minutes to hours if toxins are presentWha

What are symptoms of bacteriogenic reaction?

Fevers, chills, rigor, hypotensionHow

how can bacteriogenic be treated?

Broad spectrum antibiotics after taking blood cultures

What is a delayed hemolytic reaction?

When antibodies form to non-ABO antigens in the donor blood causing extravascular hemolysis

How long does it take for delayed hemolytic reaction to occur?

2-14 days post transfusion due to secondary exposure

What are symptoms of Delayed reaction?

Fever, malaise, jaundice or no symptoms

What should be monitored during a delayed hemolytic reaction

Hemoglobin, bilirubin, lactate dehydrogenase, haptoglobin

What does a positive DAT post transfusion mean?

Very significant and it may be the only indicator of delayed hemolytic reaction

What are indicators of intravascular hemolysis?

Visible hemolysis, hemoglobinuria, decreased haptoglobin, increased LD

What are indicators of extravascular hemolysis?

Increased Brb, LD, decreased Haptoglobin, and hemoglobin, no visible hemolysis

How should transfusion reactions be investigated?

Clerical check, review symptoms, time it was transfused, product, volume, look for visible hemolysis, perform serological and non-serological testing

What is the workup for delayed transfusion reacton?

ID Ab, perform elution on DAT positve cells, update recorsWh

What should never be done a delayed transfusion workup?

NEVER antigen type the patient because the Ag pos donor cells are in circulation