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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
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
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
- Consider CXR to help differentiate anaphylaxis, TRALI, 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
- ↑ Wagner, L. Why Should Clinicians Be Concerned about Blood Conservation? ITACCS. 2005 PDF