Transfusion reaction

• 6 blood transfusion reactions:

  Anaphylactic

  Acute haemolytic

  Delayed haemolytic

  Febrile nonhaemolytic

  Transfusion related acute lung injury

  Transfusion associated circulatory overload
• Anaphylactic:

  Type 1 hypersensitivity reaction

  Within seconds or minutes they develop urticaria and pruritis, wheezing, hypotension, respiratory arrest and anaphylactic shock.

  However can occur 2-3 hours after.

  Common in individuals which IgA deficiency
• Acute haemolytic:

  Type 2 hypersensitivity reaction

  Occurs because of ABO blood type incompatibility.

  Red blood cell destruction

  Symptoms can begin during transfusion or with 24 hours.

  Fever, hypotension, tachycardia, tachypnea, jaundice, red urine and flank pain.
• Delayed haemolytic:

  Haemolysis starts after 24 hours post-transfusion

  Minor antigens on donor blood e.g. Rh neg or pos

  Anamnestic response - previously exposed to these antigens e.g. in pregnancy or previous transfusion

  Extravascular haemolysis

  Often asymptomatic, mild fevere and jaundice.
• Febrile nonhaemolytic:

  No RBC destruction.

  Fever following blood transfusion.

  Type 2 hypersensitivity reaction

  Release of cytokines leading to heightened immune response.

  Symptoms happen 1-6 hours post-transfusion. Can include fever, chills, headache and flushing (face and neck).
• Transfusion related acute lung injury:

  Start within minutes to 6 hours.

  Two hit model: Stressor such as sepsis causes sequestion of neutrophils. Transfusion itself activates primed neutrophils causing an inflammatory response in the lungs.

  Fluid accumulation in lung interstitium (pulmonary oedema), respiratory distress (SOB, tachypnea), fever.

  Treat with supplementary oxygen.
• Transfusion associated circulatory overload:

  Fluid overload

  A patient with congestive heart failure or CKD that has a transfusion who presents after 6 hours with respiratory distress and cardiogenic pulmonary oedema.

  Treat with diuretics and oxygen.