Lecture 4: Transfusion Reactions

4 hrs

usually caused by ABO incompatibility where the complement system activates the Membrane attack complex (C5-C9)

intravascular hemolysis and cytokine storm, resulting in DIC

may lead to renal failure

• fever: increase in 1 degree
• hypotension
• hemolgobinemia
• hemoglobinuria
• renal edema

• stop transfusion but leave line open to put medication in
• treat DIC if present
• mannitol and Lasix to maintain urinary flow

• positive DAT
• elevated unconjugated bilirubin
• LDH
• haptoglobin (run by chemistry)
• schistocytes

antigens other than ABO whose titers are initially low but upon transfusion, previously sensitized antigens stimulate B memory cells to produce Ab in response

Kidd Antibodies

• drop in Hgb,HCT
• rise in unconjugated bilirubin
• DAT can be +/- if transfused red cells are removed by RES
• spherocytes: extravascular hemolysis

• leukocyte antibodies in the patient or donor unit or...
• cytokine production by donor unit causes fever

leukoreduced unit

platelet concentrate

• hypertension
• fever

• antipyretics
• r/o hemolysis (inspecting hemoglobinemia, DAT, repeat pt ABO)

allergic reaction

• Type I hypersensitivity with antibody to donor plasma proteins.
• can be rate dependent thus it is better to transfuse slowly.

allergic rxn

• antihistiminics
• may restart unit slowly after antihistamine if symptoms resolve

severe Type I hypersensitivity when large concentrations of inflammation mediators are released at one time

• IGA deficient recipient can develop naturally occurring Abs in response to exposure to IgA like substances that are ubiquitious in environment.
• IgA related anaphylactic reactions occur within the first transfused unit

• similar to anaphylactic reaction except IgE mediation is not demonstrated
• no histamine is released

• hypotension
• no fever
• dyspnea
• nausea, vomiting, diarrhea

test for presence of IgA and those who lack it test for presence of anti IgA

1-2 hours

• noncardiogenic pulmonary edema by passive transfer of ...
• donor granulocyte, HLA antibodies
• lipid activators of neutrophils contained in donor plasma

T

endotheial damage when leukocyte antibodies activate antigen positive neutrophils in the pulmonary capillaries

pregnant female donors

• acute respiratory distress
• hypoxemia
• hypotension
• fever

• chest radiographs demonstrating bilateral interstitial alveolar infiltrates
• have to rule out circulatory overload
• abrupt onset in association with transfusion
• BNP <2.0

• mortality is 1-15%
• <70% TRALI pt will require mechanical ventilation
• most patients recover within 24-48 hrs
• but TRALI is costly because it requires intensive care for treatment 2-7 days

• screen for HLA and granulocyte specific Abs in donor
• screen for granulocyte - specific Abs in recipient
• reverse lymphocyte crossmatches (recipient lymphocytes in donor serum)

donor T lymphs attacking patient tissue

• marrow and peripheral progenitor cell transplant
• premature infants
• recipients of intrauterine transfusion
• pts receiving blood components from relatives

• generalized erythematous rash with desquamation'severe diarrhea
• abnormalities of liver f(x)
• pancytopenia
• primarily seen in organs with the highest turnover rate (skin,liver,narrow and GI tract)

• almost always fatal
• treated with corticosteroids and cytotoxic agents

• irradiated (gamma)
• irradiated blood reduces the lifespan of red cells to 28 days from the date of irradiation

bacterial contamination of platelet or red cell component

• gram negative
• usually more severe shock

• gram positive
• less commonly associated with shock

• fever
• rigors
• dypsnea

reduced cardiac reserve and chronic anemia due to circulatory overload leading to cardiac hyperkinesia

BNP>2.0