04-15-2011, 02:01 PM
Acute hemolytic transfusion reaction 1. Intravascular-complement mediated-IgM 2. Fatality rate>10%, - often anti-A or anti-B 3. #1 cause is clerical error 4. Symptoms: fever, chills, hypotension, back pain, pain at infusion site
Acute hemolytic transfusion reaction treatment Stop transfusion, flush with IVF, consider diuretics, monitor for DIC and renal failure
Delayed hemolytic transfusion reaction (6) 1. 3-10 days after transfusion of blood that appeared compatible: 3 day sample expiration rule based on this 2. Patients previously immunized 3. Antibody not detected pre-transfusion: Anamnestic antibody response 4. Intra and/ or extravascular hemolysis 5. Can be severe (ARF, DIC) 6. Rh, Kidd, Duffy more commonly
Signs and symptoms of DHTR 1. Often asymptomatic 2. Fever 3. Mild Jaundice 4. Anemia
Anaphylactic reactions (7) Hypotension, Chills, Fever, Bronchospasm/dyspnea, Nausea/vomiting, Diarrhea, Urticaria
Anaphylactic treatment Antihistamine, epinepherine, steroids, supportive care
TRALI (transfusion related acute lung injury) 1. Mimics ARDS but resolves within 48 hours 2. Respiratory insufficiency, fever, chills, hypotension 3. Likely due to anti-HLA or anti-neutrophil antibodies
TACO (transfusion associated circulatory overload) 1. Typically occurs in patients with pre-existing cardiopulmonary compromise 2. May be associated with HTN 3. Improves with diuretics
PTP (post transfusion purpura) 1. Profound thrombocytopenia 1-2 wks after transfusion - platelets or RBCs 2. Multiparous females at highest risk - Anti-HPA-1A is most commonly implicated 3. Antibody to donor platelets - destruction of autologous and allogenic platelets
PTP treatment 1. IVIG. TPE
Acute hemolytic transfusion reaction treatment Stop transfusion, flush with IVF, consider diuretics, monitor for DIC and renal failure
Delayed hemolytic transfusion reaction (6) 1. 3-10 days after transfusion of blood that appeared compatible: 3 day sample expiration rule based on this 2. Patients previously immunized 3. Antibody not detected pre-transfusion: Anamnestic antibody response 4. Intra and/ or extravascular hemolysis 5. Can be severe (ARF, DIC) 6. Rh, Kidd, Duffy more commonly
Signs and symptoms of DHTR 1. Often asymptomatic 2. Fever 3. Mild Jaundice 4. Anemia
Anaphylactic reactions (7) Hypotension, Chills, Fever, Bronchospasm/dyspnea, Nausea/vomiting, Diarrhea, Urticaria
Anaphylactic treatment Antihistamine, epinepherine, steroids, supportive care
TRALI (transfusion related acute lung injury) 1. Mimics ARDS but resolves within 48 hours 2. Respiratory insufficiency, fever, chills, hypotension 3. Likely due to anti-HLA or anti-neutrophil antibodies
TACO (transfusion associated circulatory overload) 1. Typically occurs in patients with pre-existing cardiopulmonary compromise 2. May be associated with HTN 3. Improves with diuretics
PTP (post transfusion purpura) 1. Profound thrombocytopenia 1-2 wks after transfusion - platelets or RBCs 2. Multiparous females at highest risk - Anti-HPA-1A is most commonly implicated 3. Antibody to donor platelets - destruction of autologous and allogenic platelets
PTP treatment 1. IVIG. TPE