Blood Transfusion Reaction:Delayed Hemolytic Transfusion Reaction

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 :

Comparison of TAGvHD and GvHD in BMT :

	TAGvHD	BMT GvHD
Incidence	0.1 to 1.0%	30 to 70%;
Onset	2-47 days	35 to 70 days
Pancytopenia	Frequent	Rare
BM	Hypocellular	not affected
Duration of illness	<54 days	5 months
Mortality	87- 100%	5 - 10%
PREVENTION:	Irradiation of blood and blood component for patients at risk. Dose: 2500
	Irradiation of :
	Cellular component intrauterine transfusion
	Patients identified at risk for TAGvHD
	Transfusion of cellular component between blood relatives
	Transfusion of HLA selected products
MORTALITY:	87 TO 100%

Anaphylactoid reaction to ACE inhibition.

Reaction: flushing and hypotension in patients on ACE inhibitors

Mechanism : Prekallikrein present in blood and blood product is converted to vasoactive bradykinin whose metabolism is inhibited by ACE inhibitors resulting in hypotension.

Procedures associated:-Therapeutic plasma exchange with albumin replacement
- Contact of plasma with dialysis membrane

DELAYED HEMOLYTIC TRANSFUSION REACTION :

Two types :

Anamnestic response to transfused RBCs

Primary alloimmunisation

Incidence

1 : 11000 to 1 : 5000

0.05% to 0.07% of transfusion recipient

Clinical presentation :

More common in multiply transfused & Multiparous women

Occurs 3 - 7 days post transfusion

Extravascular hemolysis

Absence of anticipated Hb or HCT rise following blood

Transfusion.

Jaundice

Fever

Rarely hemoglobinuria

Antibodies implicated :
	Common antibodies	Uncommon antibodies
	Anti jka	Anti A1
	Anti E	Anti P1
	Anti D Anti C Anti K Anti Fya Rarely Anti HLA antibodies

Investigations :

Freshly draw blood to test for alloantibodies,

Compare with previous sample.

Treatment:

Rarely necessary

Observe urine output

Blood transfusion that lack the corresponding antigen.

Prevention:

Blood that lack the responsible antigen.

Issue medical alert card to these patients

Maintain record of the offending antibodies.

Next : Adverse Reactions To Blood Transfusion(Contd.)

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