Transfusion reaction

• A person’s ABO blood type describes the antigens present on their erythrocytes:

  • Group A erythrocytes only have the A antigen
  • Group B erythrocytes only have the B antigen
  • Group AB erythrocytes have both the A and B antigens
  • Group O erythrocytes do not have any ABO antigens
• ABO antibodies:

  • Group A individuals form anti-B antibodies
  • Group B individuals form anti-A antibodies
  • Group AB individuals do not form ABO antibodies
  • Group O individuals form anti-A, anti-B, and anti-AB antibodies
• Packed red cells:

  • Red blood cells
  • Only antigens of the product need to be considered
  • O patients can only receive O pRBCs
  • A patients can receive A and O pRBCs
  • B patients can receive B and O pRBCs
  • AB patients can receive AB, A, B and O pRBCs
• Fresh frozen plasma:

  • Clotting factors
  • No antigens are being transfused
  • Only red cell antibodies need to be considered
  • O patients can receive O, A, B, and AB FFP
  • A patients can receive A and AB FFP
  • B patients can receive B and AB FFP
  • AB patients can only receive AB FFP
• AB is the universal donor of fresh frozen plasma because it contains no anti-A or anti-B antibodies
• specific observations timings that should be carried out:

  • Before the transfusion starts.
  • 15-20 minutes after it has started.
  • At 1 hour.
  • At completion.
• General complications of packed red cell transfusions:

  • Clotting abnormalities - dilutional effect
  • Electrolyte abnormalities - hypocalcaemia and hyperkalaemia
  • Hypothermia
• Acute haemolytic reaction:

  • Most commonly caused by ABO group incompatibility
  • Donor red blood cells are destroyed by recipients preformed antibodies - haemolysis
  • Symptoms - urticaria, hypotension, fever, haemogloburia
  • Bloods - low Hb, low hepatoglobin, raised LDH and bilirubin
  • Positive direct antiglobulin test will confirm diagnosis
  • Urgently inform blood bank and stop transfusion
• Transfusion associated circulatory overload:

  • Presents with dyspnoea and features of fluid overload
  • Urgent CXR
  • Oxygen and diuretics
  • Patients at risk of overload can be prescribed furosemide prophylactically during the transfusion
• Transfusion related acute lung injury:

  • Form of acute respiratory distress syndrome
  • Patients are dyspnoeic
  • High mortality
  • High flow oxygen and urgent CXR
• Other complications:

  • Mild allergic reaction
  • Non-haemolytic febrile reactions
  • anaphylaxis
  • Infective/bacterial shock