Transfusion Reactions

and Treatment
 Transfusion Reactions

Immediate Delayed

 AHTR  DHTR
 FNHTR  Alloimmunization
 Allergic Reaction  Post Transf. Purpura
 Anaphylaxis and  TA-GVHD
Anaphylactoid reaction
 Acute Hemolytic Transfusion Reactions

 Occurs when incompatible eritrocytes are

transfused into a recipient who has pre-formed
antibodies (usually ABO or Rh)
 Antibodies activate the complement system,
causing intravascular hemolysis
 Symptoms occur within minutes of starting the
transfusion
 This hemolytic reaction can occur with as little
as 5-10 mL of RBC’s
 Error of labeling is most common problem
Acute Hemolytic Transfusion Reactions

Pathophysiology
Ab (in recipient serum) + Ag (on RBC donor)
↓
-Neuroendocrine responses
-Complement Activation
-Coagulation Activation
- Cytokines Effects
↓
Acute hemolytic transfusion reaction
 Signs and Symptoms of AHTR
 Chills , fever  Hemoglobinemia
 Facial flushing  Hemoglobinuria
 Hypotension  Shock
 Renal failure  Nausea
 DIC  Vomitting
 Chest pain  Back pain
 Dyspnea  Pain along infusion
 Generalized bleeding vein
 Acute Hemolytic Transfusion Reactions

 Acute onset within minutes or 1-2 hours

after transfused incompatible blood
 Most common cause is ABO- Rh
incompatible transfusion
 Pathophysiology

Two mechanisms for RBCs destruction

1) Intravascular hemolysis
2) Extravascular hemolysis
 Management of AHTR
 Stop the transfusion
 Keep IV fluid
 Notify patient’s physician and blood bank
 Take care of patient
 Perform bedside clerical checks
 Return unit, transfusion set to blood bank
 Collect appropriated post- transfusion blood
sample for evaluation
 Document reaction
 Laboratory investigation for AHTR
 Sample from blood bag Repeat ABO, Rh, Ab screening

 Patient sample

Pre Tx sample Repeat ABO, Rh, Ab screening

Post Tx sample Repeat ABO, Rh, Ab screening, DAT,

CBC, UA, Bilirubin, Ureum, Cr,

Coagulation screening

 Repeat compatibility test

- Pre Tx sample & Donor unit

- Post Tx sample & Donor unit

Acute Hemolytic Transfusion Reaction

Treatment depends on :
– Amount of incompatible blood
transfused
– Specificity of the offending antibody
– Clinical severity of the reaction
Acute Hemolytic Transfusion Reaction

Treatment
Primary concerns :
- vigorous treatment of hypotension
- promotion of renal blood flow
↓
To prevent renal failure
 Acute Hemolytic Transfusion Reaction

Prevention
 preventing or detecting errors in every phase of
the transfusion process :
 sample acquisition
 at all steps in laboratory testing
 at the time of issue
 at the time of transfusion
 Ensuring that all clinical staff recognize signs
and symptoms of acute reaction
Non-Immune-Mediated Hemolysis

Causes
 Physical or chemical destruction of blood:
freezing, heating, hemolytic drugs
 solution added to blood
 Bacterial contamination
Treatment
– depends on the causes
 mild reaction  supportive treatment
 severe reaction  intensive treatment
 Delayed Hemolytic Transfusion Reaction

• Most often the result of an anamnestic

response (transfusion, pregnancy, transplantation )
• Mild clinical signs and symptoms
• Unexpected or unexplained decreased in
Hb or Hct after transfusion (should be
investigate as possible DHTR)
 Delayed Hemolytic Transfusion Reaction

Pathophysiology
- 2 types of DHTR
1) Primary alloimmunization → Longer
2) Secondary response to transfused
RBCs → 3 – 7 days after Tx
- Extravascular hemolysis
sensitized RBCs  removed by RES
Delayed Hemolytic Transfusion Reaction

• Signs & Symptoms

–Mild fever or fever with chill

–Mild anemia
–Mild to moderate jaundice
–Uncommon  hemoglobinemia,
Hemoglobinuria, shock, renal failure
 Delayed Hemolytic Transfusion Reaction

Therapy and Prevention

- Goal of therapy is prevention
- Treat severe complication if necessary
- Alert to history of sensitization
(previous transfusion, Pregnancy, transplantation)
 Febrile Non-hemolytic Transfusion Reaction
( FNHTR )

Definition
o
Rise in patient temperature >1 C
associated with transfusion, no
precipitating factors other than blood
transfusion
 Pathophysiology of FNHTR

- Patients - Blood donors

Leucocyte antibodies leukocyte in
( HLA Ab ) transfused blood
↓
Activate complement system
↓
C 5a
↓
Pyrogen interleukin-1
(macrophage, monocyte)
Febrile Non-hemolytic Transfusion Reaction

 Signs & Symptoms

 Fever with or without chills
 Generally symptoms are mild
 Severe reaction :- hypotension,
cyanosis, tachycardia, tachypnea,
dyspnea, cough etc.
 Febrile Non-hemolytic Reaction
Treatment
 discontinued blood transfusion if the patient has
severe reaction
 Antipyretic for fever

Prevention
 using prestorage leukocyte –reduced red blood
cell or platelet
 Using single donor platelets
 Washed RBC`s
 Allergic Transfusion Reactions
Probably the most frequent kind of reaction

Pathophysiology
Allergen – Reagin (IgE,IgG)
Complex
↓
attach mast cell
↓
histamine/leukotrienes
↓
Allergic reactions
(urticaria)
 Allergic Transfusion Reactions

 Signs & Symptoms

- Urticaria
- Severe reactions are rare

 Therapy & Prevention

- Antihistamine
- Plasma – deficient blood components
 Anaphylactic and Anaphylactoid
reactions
Anaphylaxis can range from mild urticaria
to severe shock and death

Pathophysiology
- IgE antibody to IgA in donor plasma
(anti-IgA antibodies)
 Anaphylactic and Anaphylactoid
reactions
Signs & Symptoms
- Anaphylactic  coughing, dyspnea,
nausea, emesis, bronchospasm, flushing
of skin, chest pain, hypotension,
abdominal cramps, diarrhea, shock, and
death.
- Anaphylactoid (less severe) 
urticaria, periorbital swelling, dyspnea, or
perilaryngeal edema
 Anaphylactic and Anaphylactoid
reactions
Therapy and Prevention
 Stop transfusion
 Keep IV line open
 Medication :- epinephrine, corticosteroid
 Wash RBCs and blood components
 Transfuse IgA deficiency blood
Transfusion-related Acute Lung Injury
(TRALI)
Pathophysiology
Leukocyte Ab in donor react with pt. leukocytes
↓
Activate complements
↓
Adherence of granulocytes to pulmonary endothelium with
release of proteolytic enz.& toxic O2 metabolites
↓
Endothelial damage
↓
Interstitial edema and fluid in alveoli
 Transfusion-related Acute Lung Injury
(TRALI)
- Acute and severe type of transfusion reaction.
- Failure of pulmonary function usually present within 1-4
hours of starting transfusion.
Symptoms and signs
 Fever
 Hypotension
 Tachypnea
 Dyspnea
 Diffuse pulmonary infiltration on X-rays
 Clinical of noncardiogenic pumonary edema
Transfusion-related Acute Lung Injury
(TRALI)

Therapy and Prevention

 No spesific therapy
 Adequate respiratory and hemodynamic
supportive treatment
 Guidelines for the recognition and
management of acute transfusion reaction
CATEGORY 1: MILD REACTIONS
Signs Symptoms Possible cause
>Localized cutaneous >Pruritus >Hypersensitivity
reactions: (itching) (mild)
— Urticaria
— Rash
 Guidelines for the recognition and
management of acute transfusion reaction
CATEGORY 2: MODERATELY SEVERE REACTIONS
Signs Symptoms Possible cause
>Flushing >Anxiety >Hypersensitivity
>Urticaria >Pruritus (moderate–severe)
>Rigors >Palpitations >Febrile non-haemolytic
>Fever >Mild dyspnoea transfusion reactions:
>Restlessness >Headache — Antibodies to
>Tachycardia white blood cells,
platelets
— Antibodies to
proteins, including
IgA
>Possible
contamination with
pyrogens and/or
Bacteria
 Guidelines for the recognition and
management of acute transfusion reaction

CATEGORY 1: MILD REACTIONS

Immediate management

1 Slow the transfusion.

2 Administer antihistamine IM (e.g. chlorpheniramine 0.1 mg/kg or
equivalent).
3 If no clinical improvement within 30 minutes or if signs and symptoms
worsen, treat as Category 2.
 Guidelines for the recognition and
management of acute transfusion reaction
CATEGORY 2: MODERATELY SEVERE REACTIONS
Immediate management
1 Stop the transfusion. Replace the infusion set and keep IV line open with normal
saline.
2 Notify the doctor responsible for the patient and the blood bank immediately.
3 Send blood unit with infusion set, freshly collected urine and new blood samples (1
clotted and 1 anticoagulated) from vein opposite infusion site with appropriate
request form to blood bank for laboratory investigations.
4 Administer antihistamine IM (e.g. chlorpheniramine 0.1 mg/kg or equivalent) and
oral or rectal antipyretic (e.g. paracetamol 10 mg/kg: 500 mg – 1 g in adults). Avoid
aspirin in thrombocytopenic patients.
5 Give IV corticosteroids and bronchodilators if there are anaphylactoid features
(e.g. broncospasm, stridor).
6 Collect urine for next 24 hours for evidence of haemolysis and send to laboratory.
7 If clinical improvement, restart transfusion slowly with new blood unit and observe
carefully.
8 If no clinical improvement within 15 minutes or if signs and symptoms worsen,
treat as Category 3.
 Guidelines for the recognition and
management of acute transfusion reaction
 Guidelines for the recognition and
management of acute transfusion reaction
 Guidelines for the recognition and
management of acute transfusion reactions
 Guidelines for the recognition and
management of acute transfusion reaction
 Guidelines for the recognition and
management of acute transfusion reaction
 Guidelines for the recognition and
management of acute transfusion reaction
Thank you