Acute transfusion reaction

Acute

1. Intravascular Hemolytic TR
   1. ABO incompatability --> serious
   2. Sx: fever/ch/joint or back pain/shock
   3. Tx: stop, fluids+lasix, re-check blood
2. Febrile TR
   1. anitbodies --> mild
   2. Sx: fever/ch/malaise
   3. Tx: R/O above
3. Allergic
   1. Tx as allergic Rx --> range
4. Transfusion-Related Acute Lung Injury (TRALI)
   1. Sx: acute ARDS-like injury --> severe
   2. Tx: stop trans, Tx as ARDS
5. Sepsis (Bacterial Contamination)
6. Fluid Overload

Delayed

1. Extravascular Hemolytic TR
   1. days-weeks after --> mild
   2. Sx: fever/anemia/jaundice
   3. Tx: none
2. Graft-vs-Host
   1. in leukemia/lymphoma pt if given trans after chemo (use leuk-poor components)
   2. Sx: fever/rash/n/v/inc LFTs/pancytopenia --> severe
   3. Tx: no effective Tx --> death
3. Hemosiderosis

Transfusion Risk Ratios

1. 1:10 Febrile non-hemolytic transfusion reaction per pool of 5 donor units of platelets (1 pack)
2. 1:100 Minor allergic reactions (urticaria)
3. 1:300 Febrile non-hemolytic transfusion reaction per unit of RBC (1 pack)
4. 1:700 Transfusion-associated circulatory overload per transfusion episode
5. 1:5000 Transfusion-related acute lung injury (TRALI)
6. 1:7000 Delayed hemolytic transfusion reaction
7. 1: 10,000 Symptomatic bacterial sepsis per pool of 5 donor units of platelets
8. 1:40,000 Death from bacterial sepsis per pool of 5 donor units of platelets
9. 1:40,000 ABO-incompatible transfusion per RBC transfusion episode
10. 1:40,000 Serious allergic reaction per unit of component
11. 1: 82,000 Transmission of hepatitis B virus per unit of component
12. 1:100,000 Symptomatic bacterial sepsis per unit of RBC
13. 1:500,000 Death from bacterial sepsis per unit of RBC
14. 1:1,000,000 Transmission of West Nile Virus
15. 1:3,000,000 Transmission of HTLV per unit of component
16. 1:3,100,000 Transmission of hepatitis C virus per unit of component
17. 1:4,700,000 Transmission of HIV per unit of component

Source

1. 2/18/06 DONALDSON (adapted from Rosen)
2. Canadian Blood Services (Public Health Agency of Canada)