Blood Transfusion Adverse Reactions:Acute 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.

ADVERSE REACTIONS TO BLOOD TRANSFUSION :

Any adverse reaction that occurs during the administration of blood and blood component must be considered as transfusion reaction unless proved otherwise. Transfusion reactions occur in 7% to 10% of all recipient of blood or blood components. Fortunately, majority of them are minor reactions. 10% of these reactions are hemolytic and 90% of these are non-hemolytic reactions. Incidence of ABO mismatch blood being infused is 1 : 30,000 blood bag. 1 out of 10 ABO mismatch transfusion is fatal.

Transfusion reactions may be divided as follows :

Acute ( <24 hrs ) :

Immunologic:
Hemolytic transfusion reaction
Febrile non-hemolytic transfusion reaction
Allergic
Anaphylaxis
TRALI

Etiology
ABO incompatibility
Cytokines, anti-leukocyte antibodies
Antibodies to plasma proteins
Antibodies to IgA
Antibodies to leucocytes or complement
activation

Non-immunologic :
Marked fever with shock
Atypical reaction with hypotension
Congestive heart failure
Air embolism
Hypocalcaemia
Hypothermia
Hypokalemia and hyperkalemia.

Bacterial contamination
Associated with ACE inhibitors
Volume overload
Air infusion via line
Citrate toxicity
Rapid infusion of cold blood
Red cell storage

Delayed adverse reaction to transfusion (> 24 hrs) :

Immunologic :
Alloimmunization to RBC, WBC, platelets

Hemolytic
TAGvHD

Post Transfusion Purpura
Immunomodulation

Etiology :
Exposure to antigen of donor origin-Plasma protein, HLA
Anamnestic antibody to RBC antigen
Engraftment of transfused functional lymphocytes
Antiplatelet antibodies
not well understood

Nonimmunologic :
Iron overload
Transfusion transmitted diseases

multiple transfusion.
Hepatitis, HIV cytomegalovirus, etc

RECOGNITION OF ACUTE TRANSFUSION REACTION :

Signs and symptoms of Acute hemolytic transfusion reaction:

Fever with or without chills

Rigors with or without fever

Pain at infusion site or in chest, abdomen or flanks.

Acute hypotension or hypertension.

Tachypnea and hypoxemia.

Nausea with or without vomiting.

Hemoglobinuria.

Urticaria, flushing, itching or edema.

THE ROLE OF TRANSFUSIONIST IN CASE OF AN ACUTE TRANSFUSION REACTION:

First is to suspect and then is to take action.

STOP Transfusion immediately.

NOTIFY responsible physician.

MAINTAIN IV LINE with normal saline drip.

CHECK for all identifying information for clerical error.

Notify Blood bank personnel and patient's physician immediately.

Conditions requiring aggressive management need to be ruled out immediately. A physician must evaluate to rule out Acute hemolytic transfusion reaction, Anaphylaxis, TRALI, transfusion-induced sepsis.

Initiate therapeutic actions.

Collect blood samples for the blood bank as directed by them usually 3-cc EDTA blood and 5 cc in plain tube.

Blood for coagulation profile in a 10cc-citrate tube and plain tube for biochemistry, electrolytes and appropriate blood cultures.

Return discontinued blood bag along with IV administration set, attached IV solutions, all related forms and labels.

In case, the reaction is limited to urticaria or circulatory overload there is no need to evaluate post-reaction blood or urine samples.

Observe the post reaction urine sample for AIHTR.

Monitor hemodynamic status, urine output, ECG.

THE ROLE OF BLOOD BANK LABORATORY:

Check for identification error: Recheck all the steps of transfusion process. In case of misidentification, search for other patients at risk.

Visual check for hemolysis: Post reaction plasma for hemoglobinemia. Elevated bilirubin by 5-7 hrs. Post reaction urine sample for hemoglobinuria.

Serological check for incompatibility : DAT testing.

Next : Adverse Reactions To Blood Transfusion(Contd.)

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