Blood Transfusion Adverse Reaction:Anaphylactic Reaction,TRALI

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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ADMINISTRATION OF BLOOD

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Introduction

Blood Transfusion Filters and Blood Warming

Dr. Mukesh Desai
Consultant Pediatric Hematologist-H.N. Hospital,
Consultant Pediatric Hematologist-Nanavati Hospital.

Continued...

ADVERSE REACTIONS TO BLOOD TRANSFUSION :

ANAPHYLACTIC REACTION :

Incidence :	-	1 : 1,70,000
	-	1 : 18,000
Etiology:	-	Antibody to donor plasma protein.
	-	Most commonly Anti-IgA
Clinical features:	-	Occurs after infusion of few ml of blood. Cough, bronchospasm , respiratory distress, Abdominal cramps , diarrhea , shock , loss of consciousness and absence of fever
Treatment:	-	Stop transfusion
	-	Treat shock
	-	Epinephrine 0.3 to 0.5 mg C or IM 1 : 1000 solution. In severe cases 1 : 10 000 IV
	-	Steroid:- IV hydrocortisone 100 mg
	-	Antihistaminic IV, B2 agonist
Prevention:	-	TRANSFUSE BLOOD COMPONENT THAT LACK IgA
	-	Maintain donor file
	-	Deglycerolized RBC
	-	Extensively washed RBC
	-	Encourage Autologous blood transfusion
	-	Plasma component prepared from IgA deficient individuals .

TRALI (Transfusion-related acute lung injury) :

Incidence:	-	Rare
Etiology:	-	Anti HLA or Leucoagglutinin
Pathophysiology:	-	Migration of activated neutrophils to lung.
	-	Microvascular occlusion.
	-	Capillary leakage and pulmonary edema
Clinical presentation:	-	Idiosyncratic presentation with in 4 hrs of transfusion
	-	Marked respiratory distress
	-	Hypoxia, hypotension, fever
	-	Bilateral pulmonary infiltrate
Treatment:	-	High dose steroids
	-	Supportive care
	-	Ventilator support.
Prevention:		Washed RBC
	-	Microaggregate filters
	-	Leucodepletion for blood and blood component

TRANSFUSION ASSOCIATED GRAFT VERSUS HOST DISEASE :

Incidence:	-	Very rare
		1:660 in Japan
Etiology:		Transfusion of viable lymphocytes which engraft in the recipient, proliferate and initiate GvHD
	-	Immunocompromised host
	-	HLA compatible donor
	-	Blood relative
	-	HLA matched component
	-	Population with limited HLA diversity
Target organs:	-	Skin, Liver, Gastrointestinal tract, Bone marrow
Clinical features:		Begins by 10th to 12th day
	-	Erythroderma
	-	Jaundice and liver enzyme abnormalities
	-	Diarrhea 3 to 4 liters of watery diarrhea
	-	Pancytopenia
Diagnosis:		HLA typing
	-	Skin biopsy
Patient at risk:	-	Neonate, premature babies, Premature with Hemolytic disease of newborn (HDN), intrauterine transfusion, Full term and HDN requiring Exchange transfusion, Full term with neonatal alloimmune thrombocytopenia requiring mothers platelets.
	-	Congenital immune deficiency: SCID, Wiskcott Aldrich syndrome, Purine nucleotide phosphorylase deficiency, and Nezloff syndrome.
	-	Fresh maternal and paternal plasma
	-	Leukemia estimated risk 0.1 to 1%
	-	Lymphoma estimated risk 2%
	-	Post BMT
	-	HLA matched allogenic BMT
	-	Transfusion from blood relative
	-	HLA matched blood component
	-	Donor of the same ethnic back ground with limited HLA diversity
	-	Solid tumors on intensive chemotherapy.
Components implicated in TAGvHD :		Whole blood
		Packed cells
		Granulocyte pack
		Platelets
		Fresh plasma
Components not implicated in TAGvHD :		FFP
		Cryoprecipitate

Next : Adverse Reactions To Blood Transfusion(Contd.)

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