| REACTION | DESCRIPTION | FREQUENCY | TREATMENT | NOTES |
|---|---|---|---|---|
| Febrile | Patient has antibodies against donor WBCs (F>M). Transfused cytokines. |
1:100 | Tylenol (before or after). Use Leukoreduced products. |
More frequent with cellular products containing WBCs. Must be at least 1 C (1.8 F) increase over normal baseline (pre-transfusion) temperature. |
| Allergic | Patient has allergy to something in the transfused plasma (nuts, strawberries, penicillin). Rash, hives. No signficant change in BP or T. |
1:333 | Benadryl (before or after). | |
| Anaphylactic/ Anaphylactoid | Severe allergic reaction, with circulatory collapse, laryngeal edema. Hypotension, without fever. | 1:20,000- 1:47,000 |
May require intubation, pressure support, ICU. | About 1 death/year. |
Septic Reaction |
Due to bacterial contamination of unit (usually at time of donor phlebotomy). |
Plts 1:5000 RBCs 1:250,000 |
Broad spectrum antibiotics. | Plts: Staph epi Fatal in ~1:50,000 plt transfusions. |
| TACO (Transfusion Associated Circulatory Overload) |
Volume overload with cardiogenic edema. Normal to elevated BP. |
Varies with health status. Up to 10% in elderly. | Diuretics, O2. | More likely when whole blood is used. BNP may be elevated. |
| TRALI (Transfusion-Related Acute Lung Injury) |
Donor anti-HLA antibodies react with patient WBCs. Get caught up in pulmonary vascular bed and cause non-cardiogenic edema. May have low BP. Usually occurs 2-6 hours after transfusion. | 1:5000 | May require fluids. Diuretics make worse. |
More likely with Plasma components. More likely with female DONORs. BNP < 250 |
| Acute Hemolytic Transfusion Reaction | Due to patient getting an ABO-incompatible unit. Usually due to an error in patient identification. Hemaglobinuria, pain at IV site, "Feeling of impending doom," fever, circulatory collapse. | 1:250,000- Est. 1:6000- "Compatible Mistransfusions" (near misses) are even more frequent. |
Circulatory support, renal support, dialysis. | Most likely and more severe in group O patients. This is why Kaiser-WLA uses a double-check system. Non-immune hemolysis from small needles, hypotonic solution, overheating or freezing RBCs. |
| Delayed Hemolytic/ Delayed Serologic Transfusion Reaction |
Due to a non-ABO incompatibility. Patient makes antibodies to transfused red cells, hemolyses them over a 2-14 days. Fever, LDH, elevated bilirubin, jaundice. | Usually none. | Positive DAT | |
| GVHD | ||||
| Post-transfusion purpura |