Transfusion Reactions (Danny)

Acute Hemolytic Transfusion Reaction (AHTR)

• Onset During or within 24 hours

• Cause ABO incompatibility causing intravascular hemolysis

• Diagnostic criteria/distinguishing feature Positive DAT with hemolysis labs (↓ haptoglobin, ↑ LDH, ↑ bilirubin) and rapid onset

• Follow-up testing Repeat ABO/Rh, DAT, plasma hemolysis check, bilirubin, LDH, haptoglobin, coag panel

• Prevention Strict patient/unit ID verification and proper crossmatch

• Treatment Stop transfusion, maintain urine output with fluids, treat DIC if present

• Reportability Yes to FDA within 7 days for fatalities or serious outcomes

Delayed Hemolytic Transfusion Reaction (DHTR)

• Onset 3 to 14 days post transfusion

• Cause Anamnestic alloantibody production (Kidd, Duffy, Kell)

• Diagnostic criteria/distinguishing feature Delayed anemia with new alloantibody and positive DAT

• Follow-up testing Pre and post antibody screen and ID, DAT, crossmatch, hemolysis labs

• Prevention Maintain accurate antibody history in records

• Treatment Supportive care, transfuse antigen-negative units in future

• Reportability Yes if severe or life-threatening

Febrile Nonhemolytic Transfusion Reaction (FNHTR)

• Onset During or within 4 hours

• Cause Cytokines from donor WBCs or recipient anti-WBC antibodies

• Diagnostic criteria/distinguishing feature Fever ≥1°C above baseline without hemolysis and negative cultures

• Follow-up testing Rule out AHTR and sepsis (DAT, hemolysis labs, cultures)

• Prevention Use leukoreduced products

• Treatment Antipyretics, leukoreduced products for future transfusions

• Reportability No unless severe

Mild Allergic Reaction

• Onset During or soon after transfusion

• Cause Recipient IgE antibodies to donor plasma proteins

• Diagnostic criteria/distinguishing feature Urticaria and pruritus without fever or hypotension

• Follow-up testing None if mild and resolves

• Prevention Antihistamine premedication for recurrent cases

• Treatment Antihistamines, may resume transfusion if resolved

• Reportability No unless severe

Anaphylactic Reaction

• Onset Seconds to minutes

• Cause IgA-deficient recipient with anti-IgA antibodies

• Diagnostic criteria/distinguishing feature Hypotension and airway compromise without fever

• Follow-up testing IgA level and anti-IgA antibody testing

• Prevention Use washed or IgA-deficient blood products

• Treatment Stop transfusion, give epinephrine, manage airway

• Reportability Yes, life-threatening events

TRALI

• Onset Within 6 hours

• Cause Donor anti-HLA or anti-HNA antibodies causing neutrophil-mediated lung injury

• Diagnostic criteria/distinguishing feature Acute hypoxemia with bilateral infiltrates on CXR, normal BNP

• Follow-up testing CXR, BNP, donor HLA/HNA antibody screen

• Prevention Male-only plasma or HLA antibody–negative donors

• Treatment Supportive oxygen or ventilation, avoid diuretics

• Reportability Yes, fatalities and serious cases

TACO

• Onset Within 6 hours

• Cause Volume overload from transfusion

• Diagnostic criteria/distinguishing feature Dyspnea, hypertension, elevated BNP, signs of fluid overload

• Follow-up testing BNP, CXR

• Prevention Assess volume status, slow infusion rate, pre-transfusion diuretics if needed

• Treatment Stop transfusion, diuretics, oxygen

• Reportability Yes if severe or fatal

Bacterial Contamination / Septic Reaction

• Onset Minutes to hours during transfusion

• Cause Contaminated product, more common in platelets than RBCs

• Diagnostic criteria/distinguishing feature Fever, hypotension or shock with positive cultures

• Follow-up testing Gram stain and culture of product and patient blood

• Prevention Strict skin disinfection, bacterial testing of platelets

• Treatment Broad-spectrum IV antibiotics and supportive care

• Reportability Yes for all confirmed cases

TA-GVHD

• Onset 3 to 30 days

• Cause Donor T cells engraft and attack recipient tissues

• Diagnostic criteria/distinguishing feature Rash, diarrhea, hepatitis, pancytopenia

• Follow-up testing CBC, skin biopsy, liver function tests

• Prevention Irradiated cellular components for at-risk patients

• Treatment Often fatal, supportive only

• Reportability Yes, fatalities and serious events

Post-Transfusion Purpura (PTP

• Onset 5 to 12 days

• Cause Anti-HPA antibodies destroying patient’s platelets

• Diagnostic criteria/distinguishing feature Severe thrombocytopenia post-transfusion with positive platelet antibody ID

• Follow-up testing Platelet antibody ID, HPA typing

• Prevention Avoid implicated antigen in future transfusions

• Treatment IVIG, plasmapheresis, platelets only for life-threatening bleeding

• Reportability Yes if severe

Hypotensive Transfusion Reaction

• Onset Within minutes

• Cause Bradykinin accumulation in patients on ACE inhibitors receiving leukoreduced products

• Diagnostic criteria/distinguishing feature Isolated hypotension without fever, rash, or hemolysis

• Follow-up testing Exclude anaphylaxis, sepsis, and AHTR

• Prevention Avoid ACE inhibitors before transfusion if possible

• Treatment Stop transfusion, supportive blood pressure management

• Reportability No unless severe