Acute transfusion reaction: Difference between revisions
 
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==Background==
==Background==
*If concern for fluid overload, may need to transfuse as split pRBCs to tranfuse as slow as 1mL/kg/hr
*Sepsis is most commonly due to [[yersinia]], which is able to grow easily in refrigerated blood
{{Transfusion risk}}
{{Transfusion risk}}
==Clinical Features==
*Etiology specific, see ddx below


==Differential Diagnosis==
==Differential Diagnosis==
{{Transfusion reaction types}}
{{Transfusion reaction types}}


== Acute ==
{{Acute Allergic DDX}}
===Transfusion-associated circulatory overload (TACO)===
*Often confused with TRALI
*Frequently with rapid admin and large volume transfusions
*Associated with a rapid rise in blood pressure, not hypotension
*Diagnosis
**Dyspnea, orthopnea, peripheral edema, rapid rise in BP
**BNP or NT-proBNP to differentiate from other lung injury
*Treatment
**O2, supportive care, diuretics
 
===Transfusion-Related Acute Lung Injury (TRALI)===
*Due to granulocyte recruitment and degranulation within the lung
*More common with FFP and plt transfusions (extremely rare with pRBC transfusion alone)
**pRBCs do contain residual plasma and can have TRALI
*Time Frame: abrupt to within 6 hours of transfusion initiation
*Diagnosis
**ARDS-like symptoms
**B/l pulmonary infiltrates due to noncardiogenic pulmonary edema w/in 6h of transfusion
*Treatment
**Strop transfusion
**Treat like ARDS
**Avoid diuresis
 
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|''' '''
| align="center" style="background:#f0f0f0;"|'''TRALI'''
| align="center" style="background:#f0f0f0;"|'''TACO'''
|-
| Onset||Acute, within 6hrs||Often more gradual
|-
| BP||Low||High
|-
| Temp||Febrile||Normal
|-
| JVD/pedal edema||Unlikely||Likely
|-
| CVP/PAWP||Normal||Elevated
|-
| BNP||Normal||Elevated
|-
| Resp||Dyspneic||Dyspneic
|-
| CXR||B/l infiltrates||B/l infiltrates
|}
 
===Fluid Overload===
*Split pRBCs to tranfuse more slowly (as slow as 1mL/kg/hr)
 
===Sepsis===
*Most commonly due to yersinia which is able to grow easily in refrigerated blood
 
== Delayed ==
[[Extravascular hemolytic tranfusion reaction]]
 
[[Graft-vs-host disease]]


==Differential Diagnosis==
==Evaluation==
{{Acute Allergic DDX}}
*Workup of hemolytic reaction
**CBC with microscopy differential
**Formal urinalysis with bilirubin
**Haptoglobin, LDH, free hemoglobin
**Serum total and direct bilirubin
**Coombs test of pre-transfusion and post-transfusion blood
[[File:Coombs.png|thumbnail]]
*Consider CXR to help differentiate anaphylaxis, TRALI, TACO
{{TRALI vs TACO}}


==Management==
==Management==
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**Call the blood bank
**Call the blood bank
**Draw a new type + screen
**Draw a new type + screen
==Disposition==


==See Also==
==See Also==
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==References==
==References==
*Canadian Blood Services (Public Health Agency of Canada)
<references/>  
<references/>  


[[Category:Heme/Onc]]
[[Category:Heme/Onc]]

Latest revision as of 14:25, 19 September 2017

Background

  • If concern for fluid overload, may need to transfuse as split pRBCs to tranfuse as slow as 1mL/kg/hr
  • Sepsis is most commonly due to yersinia, which is able to grow easily in refrigerated blood

Transfusion Risk Ratios[1]

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

Clinical Features

  • Etiology specific, see ddx below

Differential Diagnosis

Transfusion Reaction Types

Acute allergic reaction

Evaluation

  • Workup of hemolytic reaction
    • CBC with microscopy differential
    • Formal urinalysis with bilirubin
    • Haptoglobin, LDH, free hemoglobin
    • Serum total and direct bilirubin
    • Coombs test of pre-transfusion and post-transfusion blood
Coombs.png
  • Consider CXR to help differentiate anaphylaxis, TRALI, TACO

TRALI vs TACO

TRALI TACO
Onset Acute, within 6hrs Often more gradual
BP Low High
Temp Febrile Normal
JVD/pedal edema Unlikely Likely
CVP/PAWP Normal Elevated
BNP Normal Elevated
Resp Dyspneic Dyspneic
CXR B/l infiltrates B/l infiltrates

Management

  • For all reactions:
    • Stop the transfusion (at least temporarily)
    • Call the blood bank
    • Draw a new type + screen

Disposition

See Also

References

  1. ↑ Wagner, L. Why Should Clinicians Be Concerned about Blood Conservation? ITACCS. 2005 PDF
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