Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1442 Transfusion Reactions

■Send component bag/IV tubing, blood samples& transfusion reac-

tion report form to blood bank. Send fresh urine specimen to lab to

check for hemoglobinuria.

specific therapy

■Dictated by type of transfusion reaction: informed by results of trans-

fusion reaction workup

■Acute hemolytic transfusion reaction: stop transfusion; IV fluids,

promote diuresis (furosemide), coagulation factor & platelet replace-

ment PRN

■Febrile nonhemolytic transfusion reaction: leukoreduction, anti-

pyretics, meperidine

■Allergic transfusion reaction: pre- & post-medication w/ antihist-

amines; if anaphylactic reaction, aggressive hemodynamic & respi-

ratory support incl O2, IV fluids, epinephrine, & steroids

■TRALI: O2, ventilatory & circulatory support

■Volume overload: diuresis, transfuse w/ smaller volumes over greater

time

■Bacterial contamination: IV fluids, broad-spectrum antibiotics,

coagulation factor & platelet replacement

■Delayed hemolytic transfusion reaction: transfuse w/ antigen-

negative RBCs if necessary

■Transfusion-associated GVHD: no effective therapy, although corti-

costeroid & immunosuppressive therapy employed w/ limited effi-

cacy. Prevented by blood product irradiation.

■PTP: IVIg, steroids, plasmapheresis, PLA-1-negative blood products

follow-up

n/a

complications and prognosis

■Acute hemolytic transfusion reaction: 1/30,000 transfusions w/ 5%

mortality

■Febrile nonhemolytic transfusion reaction: 1/200 transfusions w/ no

impact on morbidity & mortality

■Allergic transfusion reaction: mild urticaria in 1/100 transfusions

w/ no impact on morbidity & mortality; anaphylaxis in 1/20,000 to

1/50,000 transfusions w/ appreciable morbidity & mortality

■TRALI: 1/5,000 transfusions w/ up to 5–10% mortality

■Bacterial contamination leading to sepsis: 1/20,000 apheresis

platelet transfusions & 1/500,000 RBC transfusions w/ significant

morbidity & mortality