Transfusion reactions

Yaw Addai-Mensah
MD MSc Ph.D
• The adverse symptoms produced by an
erythrocyte incompatibility between a patient
and a unit of donor blood.
• Allergic reactions, shortened post transfusion
red cell survival, disease transmission also
part.
• Symptoms usually occur during or shortly
after a transfusion
• Haemovigilance the key to detecting them.
• Risk benefit analysis very important in
deciding on transfusion.
• The ordering physician should be promptly
informed in the event of an adverse reaction.
• Rate of all adverse reactions to transfused
blood, about 1 in 200 transfusions.
• Fatality from blood transfusion approximately
one in a million units transfused.
 Causes of fatal reactions
• Misidentification of patients
• Mislabelling of blood samples
• Errors in laboratory records
• Mistakes in blood typing
• Inaccurate antibody screening or cross-
matching
 Classification
• Haemolytic vs. non-haemolytic
• Acute(immediate) vs. delayed.
• Acute haemolytic reactions -during or
immediately after transfusion
• Delayed reactions may not express
themselves until 7-10 days post transfusion.
• Many reactions demonstrate both intra- and
extravascular haemolysis
Types of transfusion reactions
• Immediate haemolytic- intravascular
haemolysis
• Delayed haemolytic-extravascular haemolysis
• Immediate non-haemolytic-febrile
reactions,anaphylaxis, urticaria,pulmonary
oedema(non cardiac),fever and shock
• Delayed non-haemolytic-G vs H disease, post
transfusion purpura,infectious diseases, iron
overload
 Acute haemolytic reactions
• ABO incompatibility the most common
cause
• Other blood groups may be responsible
in patients with pre-existing antibodies
from pregnancy or prior transfusion.
• Ag-Ab complexes activate complement
• Other initiators-bacterial contamination,
t’fusion of haemolysed blood.
 Signs and symptoms
• An emergency
• Reactions can occur with as little as 5ml
of blood
• Fever the most common initial symptom
• Lower back pain
• Facial flushing
• Dyspnoea
• Hypotension
• Pain at infusion site
• Oliguria
• Anuria
• DIC
• Renal failure
 TRALI

▪ Dyspnoea, tachypnoea, oxygen

desaturation, pulmonary oedema
▪ 2 pathophysiologic mechanisms cited
▪ Ab hypothesis; HNA HLA Ab in t’fused
component/neutrophil Ag in recipient
▪ Neutrophil priming hypothesis
 Prevention
• Proper ID of patients, samples
• Error free lab record keeping
 DELAYED HAEMOLYTIC REACTIONS

• Often under diagnosed, under reported,

and underrated
• Can occur from 2 days to several days
post transfusion
• May be of two types
– Anamnestic
– 10 alloimmunization
• Anti-E, anti C, anti-M etc etc.
 Signs and symptoms

• May be asymptomatic
• Fever the most common
• Triad of fever, haemolysis and recent
t’fusion very suggestive.
• Oliguria
• Renal failure
• DIC in rare cases
• Anamnestic response-
– fever, post-t’fusion jaundice, sudden drop
in Hb and PCV
– No evidence of haemorrhage or
haemodilution within 2 days post-t’fusion
• The antibody produced is largely IgG
and rarely causes intravascular
haemolysis
 Prevention
• Blood specimen for compatibility testing
should not be more than 3 days old at
the time of transfusion.
• General measures
 Immediate nonhaemolytic
reactions
• These reactions are usually not
associated with erythrocyte haemolysis
• Febrile reactions
• Platelet reactions
• Allergic and anaphylactoid reactions
• Anaphylactic reactions
• Bacterial endotoxemia
• Sepsis
• Circulatory overload
 Delayed nonhaemolytic
reactions
• Graft vs. Host disease
– Immunocompromised patients.
• Non cardiac pulmonary oedema
syndrome
– Complication of granulocyte t’fusion
– Precise cause unknown
– Increases with parity in women
• Post t’fusion purpura
– Blood or platelet containing components.
 Management of Transfusion
reactions
• Stop the transfusion immediately-dose
dependence
• Keep line open with saline
• Support the patient’s symptoms with
medical therapy
• Perform a bedside clerical check
• Look at the remaining blood for
evidence of haemolysis.
• Complete an adverse reaction form and
notify the transfusion lab.
• Return the remainder of the blood in the
bag to the lab for investigations.