Blood Transfusion Reactions Immune Mediated: • Febrile Non-Hemolytic Transfusion Reaction (FNHTR): Most common immune reaction to transfusion. Occurs within 4 hours of transfusion due to accumulated inflammatory cytokines in the banked donor blood. May recur; 25% of patients who had FNHTR once had another reaction subsequently. • Acute Hemolytic Transfusion Reaction (AHTR): Occurs during or shortly after transfusion. Occurs due to mismatch of donor antigens (often ABO/Rh) & recipient antibodies leading to hemolysis & agglutination. S/sx: Fever, flank pain, dark urine, DIC, hypoTN, renal failure. Hemolysis on labs (↓haptoglobin, ↑LDH, etc) • Delayed Hemolytic Transfusion Reaction (DHTR): Occurs 24 hours to 30 days after transfusion due to mismatch of minor antigens (often false negative crossmatch). 2nd exposure can be faster, more severe. May have drop in Hct, fever, minor hemolysis. • Allergic reaction: Usually anaphylactoid (not lgE mediated). S/sx urticaria, maculopapular rash, pruritis, fv & hypoTN. Occurs minutes to hours after transfusion, due to antibodies against proteins on plts, leukocytes, or in plasma, including IgA (in recipients w/ IgA deficiency) • Post Transfusion Purpura (PTP): Occurs 7-10 days after transfusion, due to anti-platelet antibodies in donor blood. Causes purpura & severe thrombocytopenia, may be life-threatening. More common in women (85%) & Caucasians. • Transfusion Related Acute Lung Injury (TRALI): Leading cause of transfusion related death (15% mortality). TRALI resembles ARDS, onset is 4-6 hours after transfusion. Most common following platelet transfusion from multiparous female donors (due to anti-HLA or anti-HNA Ab) • Transfusion Associated Graft Versus Host Disease (TA-GVHD): Occurs 8-10 days post transfusion, donor attack immunosuppressed recipient. Sx include: fever, cutaneous eruptions, diarrhea, liver abnormalities. May progresses to pancytopenia due to marrow aplasia. High mortality. Non-Immune Mediated: • Transfusion Cardiac Overload (TACO): Occurs between 0-6 hrs after transfusion. Volume overload from transfusions, particularly in patients with CHF. Presents as dyspnea potentially progressing to severe hypoxemia. • Hypocalcemia, Hyperkalemia: Citrate in RBCs binds to serum calcium. Blood products contain potassium from lysed cells. • Hypothermia: Due to low temp of transfused products. Iatrogenic hypothermia exacerbates coagulopathy & ↑bleeding • Hypotension: People taking ACEi may develop due to inability to break down bradykinin in transfused blood. Infection - Infection occurs due to untested organisms (rare), false negatives on testing (very rare), or bacterial contamination. • Bacterial contamination: Platelets (stored at RT) are more likely to cause infections with skin flora (GPCs). RBCs (stored at 4C), are more likely to contaminated with GNRs. Can lead to sepsis. • Untested organisms: Organisms NOT tested include: Malaria, Borrellia (Lyme disease), Trypanosoma (Chagas disease), Babesiosis & vCJD (varies by country) • False negative: Extremely rare - HIV 1 in 2,000,000,000, HBV 1 in 100,000,000, HCV 1 in 2,000,000, HTLV 1 in 650,000 Excerpted from original infographic by Nick Mark MD @nickmmark #Blood #Product #Transfusion #diagnosis #management #hematology #reactions
