URTICARIAL TRANSFUSION REACTIONS
TRANSFUSION-RELATED ACUTE LUNG INJURY
POSTTRANSFUSION PURPURA
ANAPHYLACTIC TRANSFUSION REACTIONS
DELAYED HEMOLYTIC TRANSFUSION REACTIONS
ACUTE HEMOLYTIC TRANSFUSION REACTIONS
FEBRILE NONHEMOLYTIC TRANSFUSION REACTIONS
The major immunologic reaction transfusion
-Febrile nonhemolytic transfusion reactions-Acute hemolytic transfusion reactions
-Delayed hemolytic transfusion reactions-Anaphylactic transfusion reactions
-Urticarial transfusion reactions
-Transfusion-related acute lung injury
-Post transfusion purpura
-graft-versus-host disease
Management
The management of FNHTRs consists of thefollowing steps:
-Stopping the transfusion and determiningthat a hemolytic reaction is not taking place .
Transfusion
ACUTE HEMOLYTIC TRANSFUSION REACTIONS :
They are usually due to ABO incompatibility
presenting triad of fever, flank pain, and red orbrown urine . Fever and chills in patients underanesthesia or in coma, DIC may be the presentingmode, with oozing from puncture sites andhemoglobinuria. , fever is also the presenting signof a "benign" FNHTR.
-Stop the transfusion, but leave intravenous line attached -b Begin an infusion of normal saline (not Ringer's or dextrose)
- From the other arm, obtain a sample for a directantiglobulin test and for plasma free hemoglobin - Save a urine sample for hemoglobin testing, alert theblood bank, and check for clerical error
The major immunologic reaction to blood Transfusion are:
-Febrile nonhemolytic transfusion reactions
-Acute hemolytic transfusion reactions
-Delayed hemolytic transfusion reactions
-Anaphylactic transfusion reactions
-Urticarial transfusion reactions
-Transfusion-related acute lung injury
-Posttransfusion purpura
-Graft-versus-host disease
Treatment of acute reaction:
hypotension, and pink plasma or urine that anAHTR is possible, generous fluid replacementwith saline (100 to 200 mL/h) to support a urineoutput above 100 mL/h should be initiated whilelab tests are awaited in an attempt to preventthe development of acute renal failure.
The beneficial effect of urinary alkalinization inpatients with marked hemoglobinuria is uncertain.
Delayed hemolytic transfusion reactions(DHTRs) are due to an anamnestic antibodyresponse occurring after reexposure to aforeign red cell antigen previously,transplantation, or pregnancy.
The antibody, often of the Kidd or Rhsystem, is undetectable on pretransfusiontesting,
but increases rapidly in titer following thetransfusion.
ANAPHYLACTIC TRANSFUSION REACTIONS
Rapid onset of anaphylaxis, manifested by shock,hypotension, angioedema, and respiratory distress,
An anaphylactic transfusion reaction (ATR) mayoccur within a few seconds to a few minutesfollowing the initiation such as frozen or liquidplasma, red cells, platelets, granulocytes,cryoprecipitate, or gamma globulin;
They are not generally seen following theadministration of normal serum albumin, plasmaprotein fraction, or coagulation factors.
It is the rapid onset that is characteristic of an ATR.
Complications of Immune ReactionComplications of Immune Reaction
Discomfort
Lung disfunction
Treatment of ATR
Treatment ATR consists of the following steps:
-Immediate cessation of the transfusion -Epinephrine, 0.3 mL of a 1:1000 im-solution Preparation, for possible administration,- intravenous epinephrine drip -Airway maintenance, oxygenation -Volume maintenance with saline -Vasopressors (eg, dopamine), if necessary
Prevention consists of establishing the diagnosis after the factand using either IgA-deficient blood products, which can beobtained through large, regional blood centers, or "ultra-washed" red cell or pl
Heart rate was found to increase linearly inresponse to the acute isovolemic anemia, andcould be described by the following formula:
Heart rate (beats/min) = 116 - 4.0 x Hgb(g/dL)
Tests of reaction:Tests of reaction:
leukoreduction to eliminate leukocyte debris and leukocyte-generated cytokines would be performed on all cellularcomponents intended for transfusion. This policy cannotcurrently be implemented because of cost considerations. Atpresent the following patients should receive leukoreducedblood components:
Chronically transfused patients Potential transplant recipients Patients with previous febrile nonhemolytictransfusion reactions CMV seronegative at-risk patients for whomseronegative components are not available
Washed red cells :
In order to prevent or eliminate complications associated with infusion ofproteins present in the small amount of residual plasma in red cellconcentrates, the unit of blood can be washed immediately before infusion.This approach is indicated for the following conditions:
Patients with severe or recurrent allergic reactions (eg, hives)associated with red cell transfusion Certain patients with IgA deficiency when IgA deficient donorsare not available (although frozen deglycerolized red cells may bethe component of choice; see below); patients with IgA deficiencymay have circulating anti-IgA antibodies that react with IgA in thedonor plasma In patients with T-activated red cells
In the rare patient with a complement-dependent autoimmunehemolytic anemia to prevent complement infusion.
Irradiated red cells
In order to avoid the occurrence of graft-versus-host disease (GVHD) in patients whohave hereditary immune deficiency states,transfused red cells must be subjected toirradiation with at least 2500 Gy to prevent thedonor T lymphocytes from dividing in therecipient. Irradiation to prevent GVHD is alsorecommended for red cells collected fromrelatives entered in directed donationprograms.
