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Updated: Jan 3 2022

Transfusion

  • Overview
    • Common/minor adverse reactions to blood transfusion
      • febrile non-hemolytic transfusion reaction
        • occurs a few hours after a transfusion
        • presents with minor fever/chills
        • caused by host antibody response to donor WBC antigens
        • responds well to NSAIDs (no therapy needed)
        • no hemodynamic abnormalities
      • transfusion-related acute lung injury (TRALI) aka leukoagglutination reaction
        • antibodies in donor blood against receipient white cells
        • occurs 30 minutes after transfusion
        • shortness of breath common
        • transient infiltrates seen on chest radiograph
        • treatment
          • none
          • resolves spontaneously
      • IgA deficiency
        • anaphylaxis against donor IgA (the patient has no IgA and forms an immune response against it)
        • immediately after receiving transfusion patient experiences
          • hypotension
          • shortness of breath
          • tachycardia
        • labs
          • normal LDH and bilirubin (against the IgA not the RBC's)
        • treatment/prevention
          • use blood donations from IgA deficient donors
      • minor blood group incompatibility
        • immune reaction to Kell, Lewis, Duffy, or Kidd antigens or Rh incompatibility
        • presents as delayed jaundice, poor increase in hematocrit from transfusion, but otherwise asymptomatic
        • treatment
          • none
          • resolves spontaneously
    • Serious adverse reactions to blood transfusion
      • ABO incompatibility
        • occurs duringa transfusion
        • acute symptoms of hemolysis (hypotension, tachycardia)
        • other symptoms include back pain, chest pain, dark urine
        • labs
          • LDH and bilirubin are elevated
          • haptoglobin decreased
        • treatment
          • stop transfusion and obtain sample for direct Coombs test
      • dilutional pancytopenia
        • infusions of RBCs/fluids dilutes blood cells through plasma expansion and results in pancytopenia
    • Other effects
      • citrate toxicity
        • an anticoagulant used in blood products
          • chelates calcium and magnesium
          • normally rapidly metabolized by liver
        • may cause hypocalcemia and hypomagnesemia leading to paresthesias
      • hyperkalemia
        • RBC's leak K+ during storage
      • pseudohyperkalemia
        • damage to RBC's from tourniquet placement or a lab phenomena
        • requires no treatment, not genuine hyperkalemia
      • coagulopathy
        • may require transfusion of FFP and platelets
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