Updated: 4/14/2017

Transfusion

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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 during a 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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