Internal Medicine

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

1440 Transfusion Reactions

➣Acute hemolytic transfusion reaction: most common w/ trans-

fusion of ABO-incompatible RBCs

➣Febrile nonhemolytic transfusion reaction: most common w/

platelet & RBC transfusions

➣Allergic transfusion reaction: most common w/ platelet & FFP

transfusions

➣Acute transfusion-associated lung injury (TRALI): most common

w/ FFP transfusions but can occur with any plasma-containing

component

➣Volume overload

➣Bacterial contamination: most common w/ platelet blood prod-

ucts

■Delayed transfusion reaction: transfusion w/ any blood product

within past 4 wk:

➣Delayed hemolytic transfusion reaction: most common w/ RBC

transfusions

➣Transfusion-associated GVHD

➣Post-transfusion purpura (PTP): almost always in multiparous

women

Signs & Symptoms

■Acute transfusion reactions:

➣Acute hemolytic transfusion reaction: fever, flank pain, chest

pain, hypotension, respiratory distress, hemoglobinuria, DIC,

renal failure, impending sense of doom

➣Febrile transfusion reaction: temperature increase of 1 degree C

during or immediately after transfusion

➣Allergic transfusion reaction: urticaria, pruritus, wheezing,

cough laryngeal edema, flushing, hypoxemia, nausea, vomiting,

diarrhea, hypotension, shock

➣TRALI: respiratory distress w/ pulmonary edema in absence of

heart failure within several hr of transfusion

➣Volume overload: respiratory distress w/ pulmonary edema

within several hr of transfusion

■Delayed transfusion reactions:

➣Delayed hemolytic transfusion reaction: fever, unexplained ane-

mia, jaundice days to weeks after transfusion

➣Transfusion-associated GVHD: fever, rash, enterocolitis, hepati-

tis, pancytopenia

➣PTP: severe thrombocytopenia within several d after transfus-

ion