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Acute Transfusion

Reactions
For Nurses
Maha Badawi
Transfusion Medicine Fellow
July 4.2013

Objectives
Identify common and serious acute
transfusion reactions.
Describe assessment of patients
experiencing transfusion reactions.
Recognize the importance of
reporting transfusion reactions

Transfusion Reactions
Definition: undesirable and
unintended responses to the
administration of blood or blood
components that is considered to be
definitely, probably or possibly
related to the administration of the
blood product.

Classification
Acute vs delayed
Will focus on acute reactions in this
talk

Acute Transfusion Reactions

Remember
Signs and symptoms are not specific
for one type of reaction.

Fever
Defined as a rise of temperature by
at least 1C during or within 4 hours
of transfusion of a blood product.
Febrile non hemloytic transfusion
reaction is a diagnosis of exclusion.

Fever
Can be caused by:
Febrile non hemolytic transfusion
reaction
Bacterial contamination (more common
with platelets)
Acute hemolytic transfusion reactions
TRALI
Underlying unrelated cause

Fever
Given the differential diagnosis includes
some life-threatening conditions, fever
should be taken seriously.
The transfusion should be stopped.
Ensure IV access maintained.
Recheck units and patient identifiers.
Assess vitals, other symptoms and signs.
Call MD.

Fever
Worrisome findings include:

Temperature 39C
Nausea /vomiting
Hypotension/shock
Tachycardia
Rigors/chills
Shortness of breath
Back or chest pain
Hemoglobinuria / oliguria
Bleeding from IV

Serious findings? This is likely a serious


event

Management
Patient assessment is necessary to
rule out a serious transfusion reaction
MD might prescribe paracetamol.
May restart the transfusion only with
MD authorization.
Report the reaction.
Send samples + unit to the blood
bank as necessary.

Allergic Reactions
Commonly limited to urticaria
Rarely involve more severe features
e.g angioedema or bronchospasm.
Inform MD
Antihistamines might be prescribed.
MD might decide to resume the
transfusion after symptoms resolve.

Life-threatening Reactions
Acute hemolytic transfusion
reactions
Transfusion associated circulatory
overload
Transfusion associated acute lung
injury
Bacterial contamination
Anaphylaxis

Acute Hemolytic Transfusion


Reactions
Causes:
ABO incompatibility
Undetected alloantibody
Release of blood in emergency settings
without full pre transfusion testing

Commonly caused by clerical errors


at time of sample collection or unit
assignment/issuing/transfusion

Acute Hemolytic Transfusion


Reactions
Potential symptoms
Fever

Shock
Rigors
Pain at
infusion
site
Nause
a/vomi
ting

Chest
tightne
ss

Hypotension
Hypertension

Hypoxia
Feeling
somethin
g is wrong

Anxiety

Tachycar
dia

Back
pain

Dark
urine

Low
urine
output

Acute Hemolytic Transfusion


Reactions
What to do if suspected?
Stop the transfusion immediately
Disconnect the transfusion tubing (but
keep it attached to the unit).
Run normal saline to keep vein open
Assess vitals and check ABCs
Re check units and patient identifiers
Inform the blood bank and MD
immediately

Dyspnea
TRALI (Transfusion related acute lung
injury)
TACO (Transfusion associated circulatory
overload)
Anaphylaxis
Dyspnea secondary to underlying disease

TRALI
Acute lung injury
Acute onset
Hypoxemia:
PaO2/Fi02 <300 mmHg OR
SpO2 <90% in room air

CXR showing bilateral lung infiltrates


No evidence of overload

TRALI
ALI during or within 6 hours of completion of
transfusion, with no other risk factors for ALI
(pneumonia, sepsis, burns etc)

TRALI

Under-recognized and under-reported.


1 in 2000-5000
10-20 % mortality
The leading cause of transfusion
related mortality
72% of reported cases required
mechanical ventilation
May resolve in 24-72 hours

TRALI
Investigations and management:
CXR +/- ABG
Supportive care
Steroids and diuretics are not believed to be
useful in treating TRALI

Accurate reporting is critical (including


documentation of volume assessment and
performing a CXR in the acute setting)

Reporting Transfusion
Reactions
It is essential to report ALL
transfusion reactions.
The blood bank needs to quarantine
associated blood products if the
quality of the prodcut is in question
Events related to misidentification
usually invlove more than 1 patient.

Reporting Transfusion
Reactions
We are under-reporting significantly
in KAUH.
Barriers to reporting?

QUESTIONS