Blood Transfusion Adverse Reaction:Febrile Non 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 :

FEBRILE NON-HEMOLYTIC TRANSFUSION REACTION : (FNHTR)

Definition :	-	Rise in temperature of 1 degree Celsius with or without rigors.
Incidence :	- -	Common , 0.5 to 1 %. Higher incidence in multiple transfused and multiparous females.
Etiology :	-	Antibodies to leucocytes ; Cytokine release.
Clinical picture :	-	Fever with or without chills. Mild temperature rise early in transfusion or 1 to 2 hrs later which is responsive to antipyretic.
Warning sign :	-	Severe rigors, temperature more than 40 degree Celsius suggests bacterial sepsis.
Recurrence :	-	1 out of 7 with previous FNHTR.
Management :	- - - -	Diagnosis of exclusion. Stop transfusion till hemolytic transfusion reaction ruled out. Restart blood transfusion slowly. Supportive treatment with Chlorpheniramine 50 mg & paracetamol.
Prevention :	- - -	Use leucodepletion filters if patient has more than 2 FNHTR. Use saline washed RBCs. Premedication with paracetamol.

ALLERGIC URTICARIAL REACTION :

Incidence :	-	1 to 3%
Etiology :	-	Antibodies to donor plasma proteins.
Clinical picture :	-	Itching, urticaria, rash, flushing and rarely laryngeal edema & Bronchospasm. It occurs towards the end of transfusion or after transfusion.
Management :	- - - -	No need to stop transfusion IV Chlorpheniramine IV Hydrocortisone Subcutaneous adrenaline 1:1000 if there is laryngeal edema
Prevention :	- -	Prophylactic Chlorpheniramine Saline washed RBC.

ACUTE IMMUNE HEMOLYTIC TRANSFUSION REACTION (AIHTR):

Incidence :	- -	1 : 30 000 blood bag transfused in Britain 1 : 33000 to 1 : 12000 in USA.
Fatality rate :	- - -	Commonest cause of transfusion related mortality. 1 : 10 reaction in Britain. 6% in USA.
Etiology :	- - - - - -	Almost always due to ABO mismatch blood transfusion. Rarely due to anti Lewis, anti P and anti H. Occur in emergency, ICU setting or in operation theatre. Invariably due to human error. Clerical error in labeling or mix-up of samples. Technical error in grouping and compatibility testing.
Pathophysiology:	- - - - - - - - - -	Catastrophic event following hemolytic reaction when transfused RBCs interact with preformed antibodies in recipient. Severity is related to amount of blood transfused. Reaction may occur with as little as 10 to 15 ml of blood. Most reactions occur in the first ½ hr of starting the transfusion. Neuroendocrine response: Ag +Ab + XIIa -activation of kinin bradykinin pathway. Increased capillary leak, vasodilatation, shock and hypotension. Complement activation: C3a-C5a - shock , hypotension , bronchospasm C5-9- hemolysis Coagulation activation: DIC. Cytokines release: IL 6, 8, TNF alpha- fever, hypotension, activation of coagulation pathway, DIC, Renal failure.
Clinical features :
Symptoms :	-	Chills, flushing, sweating, chest pain, pain at infusion site, back pain, abdominal discomfort, nausea, vomiting and restlessness.
Signs :	-	Fever with rigors, hypotension, tachycardia, hemoglobinuria, dyspnea, anuria / oliguria, tachypnea, cyanosis, pallor, shock and DIC.
Unconscious patients :	-	Uncontrolled bleeding (DIC) Hypotension Hemoglobinuria

"Any febrile reaction is treated as AIHTR unless proven otherwise."

Next : Adverse Reactions To Blood Transfusion(Contd.)

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