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 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