A. Transfusion Reactions:

May be allergic or hemolytic

1. Hemolytic reactions: can be acute or delayed

Acute Hemolytic reactions:

• It is usely due to ABO incompatibility, there is intravascular hemolysis
• As low as 10 ml of blood can produce hemolytic reactions
• Clinically, patients presents with complains of pain and burning in vein and fever with chills and rigor, nausea and vomiting, flushing, chest and flank pain and dyspnea.
• It is confirmed by hemoglobinuria
• ARF can occur due to blockage of tubules

Management:

• Stop infusion
• Recheck the blood details
• Maintain urine output by mannitol and fruit administration
• Alkalinize urine
• Hemodialysis

Delayed Hemolytic Reactions:

• Are extravascular hemolytic reactions
• Mainly due to Rh system and other system incompatibility eg. Kell Duffy
• These reactions are mild and seen after 21 days
• Diagnosed by Coomb’s test
• Treatment is supportive

2. Allergic reaction:

• These are mainly mild, seen as urticaria and are mainly due to plasma proteins
• Treatment is antihistaminics and steroids
• If anaphylaxis occurs, stop transfusion
• Adrenaline and steroids

B. Febrile Reactions:

Due to infusion of white cell microaggregates
Can be minimized by using microfilter blood sets with pore size 20-40 micrometer
Generally require no treatment

C. Infectious Complications:

• Hepatitis: 90% are due to hepatitis C virus
• HIV/AIDS
• Other viral diseases like CMV, EBV, HTLV-1, HTLV-2, parvovirus
• Bacterial infections like Pseudomonas, Staphylococcus, Syphillis, Brucellosis, Salmonella, Yirsenia and rickettsial disease
• Parasitic infections like malaria, toxoplasmosis, filariasis, trypanosomiasis, Creuz-Jackobs Disease (prion)

D. Fluid Overloading and Pulmonary Edema

E. Metabolic Complications:

• Hyperkalemia
• Hypocalcemia
• Acid-base abnormalities

F. Coagulation abnormailities:

Occurs due to dilution of coagulation factors and platelets
Treatment is fresh blood
Fresh frozen Plasma
Specific blood components therapy
Platelets

G. Hypothermia: Blood should be warmed before use

H. Immunosuppression- graft vs host reaction

I. Tissue hypoxia – due to shift of oxygen dissociation curve to left due to decreased 2,3 DPG

J. Endotoxaemia and Septicaemia

K. ARDS (Acute Respiratory Distress Syndrome) – now known as TRALI (Transfusion Related Acute Lung Injury)

L. Disseminated Intravascular Coagulation (DIC)

Tags: bt. blood transfusion reactions

Last updated: December 29, 2010

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