Acute transfusion reaction

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

TRALI vs TACO
TRALI TACO
OnsetAcute, within 6hrsOften more gradual
BPLowHigh
TempFebrileNormal
JVD/pedal edemaUnlikelyLikely
CVP/PAWPNormalElevated
BNPNormalElevated
RespDyspneicDyspneic
CXRB/l infiltratesB/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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