TRANSFUSION REACTIONS

IMMEDIATE HEMOLYTIC TRANSFUSION REACTION

• Intravascular lysis of transfused rbcs by complement, IgM

• Causes:
 Transfusion of ABO-incompatible blood
 Transfusion of ABO-incompatible plasma
 Non-ABO antibodies

• Clinical manifestations:
 Fever (but most febrile reactions not hemolytic)
 Back pain
 Dark or red urine (hemoglobinuria)
 Bronchospasm
 Shock
 DIC
 Organ failure (esp kidneys)
 Death
IMMEDIATE HEMOLYTIC TRANSFUSION REACTION
Evaluation of suspected cases
• Check blood product/paperwork to ensure correct
product given
• Notify blood bank/transfusion service
• Obtain blood and urine samples:
 Plasma and urine hemoglobin
 Direct Coombs test
 Repeat crossmatch/antibody screen
 Repeat ABO/Rh typing
IMMEDIATE HEMOLYTIC TRANSFUSION REACTION
Management
• Stop transfusion immediately
• IV crystalloid or colloid
• Maintain BP, heart rate
• Maintain airway
• Diuresis
 fluid,
loop diuretic (mannitol may cause
volume overload)
• Monitor renal and coagulation status
DELAYED HEMOLYTIC TRANSFUSION REACTION

• IgG-mediated lysis of transfused red cells

(usually extravascular, non-ABO)

• Usually begins 5-10 days after transfusion

• Jaundice, falling Hct, positive direct Coombs
test, fever

• Not generally life-threatening

 FEBRILE, NONHEMOLYTIC TRANSFUSION
REACTION

• Cause: cytokines released by leukocytes during

storage; antibodies to HLA antigens on transfused
or donor PMNS
• Incidence: ≤0.5% of units transfused
• More common in multiply transfused recipients
• Fever, chills, respiratory distress in severe
reactions
• Reduced incidence/severity with leukocyte-poor
product
TRANSFUSION-RELATED ACUTE LUNG INJURY
(TRALI)
• Hypoxemia with bilateral pulmonary infiltrates
• No increase in central venous or pulmonary artery
pressures
• Usually begins acutely within 6 hours of
transfusion
• Clinical: acute respiratory distress, fever, chills
• Pathophysiology:
1. Underlying lung injury (eg, sepsis, pneumonia) causes
PMNs to adhere to pulmonary capillaries
2. Mediators in transfused blood product (neutrophil
antibodies, cytokines) activate PMNs with resultant
capillary injury
TRANSFUSION-RELATED ACUTE LUNG INJURY
TRANSFUSION-RELATED ACUTE LUNG INJURY
(TRALI)
• Risk: FFP > platelets > RBC
• Treatment: stop transfusion (if still in progress);
oxygen; ventilatory support if necessary; pulse
corticosteroids
 OTHER ACUTE NON-INFECTIOUS
COMPLICATIONS OF TRANSFUSION
• Allergic reactions
• Anaphylaxis (IgA-deficient recipient)
• Lung damage from microaggregates (massive
transfusion)
• Transfusion-associated circulatory overload
(“TACO”)
• Bacterial infection (mainly with platelet transfusion)
• Hypothermia (rapid infusion of refrigerated blood)
• Citrate toxicity/hypocalcemia (massive transfusion
or apheresis)
• Graft-vs-host disease
• Air embolism
 Transfusion-related deaths 2005-2010
TRALI TACO HTR HTR Bacterial Anaphylaxis
(non-ABO) (ABO) Infection
2005 29 1 16 6 8 0

2006 35 8 9 3 7 1

2007 34 5 2 3 6 2

2008 16 3 7 10 7 3

2009 13 12 8 4 6 1

2010 18 8 2 2 2 4

• TRALI – Transfusion-associated lung injury

• TACO – Transfusion-associated circulatory overload
• HTR – Hemolytic transfusion reaction