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ADVERSE EFFECTS OF TRANSFUSION REACTION Dr. Moe Thida Aye Junior Consultant Pathologist Hpa‐an General Hospital 16/03/2010 1 Hpa_an_MMA
ADVERSE EFFECTS OF TRANSFUSIONREACTIONDr.MoeThidaAyeJuniorConsultantPathologistHpa‐anGeneralHospital
16/03/2010
1
Hpa_an_M
MA
Acute transfusion reaction occur in 1 to 2% of transfusion
patients.
With the exception of Hypersensitivity reaction and febrile
non haemolytic transfusion reaction all are potentially fatal
and require urgent treatment.
With rapid recognization and management , we can save
the life of patient.
2
• Delay and failure to do correct procedure are commonest
cause of life threatening acute transfusion reaction.
• It is essential to monitor the transfusion patient closely to
detect early sign and symptom of acute transfusion
reaction. (especially within first 15 mins for each unit)
• In severe haemolytic transfusion reaction, signs and
symptoms occur very quickly within minutes of infusing
only 5‐10 ml of blood. 3
If you suspect an acute transfusion reaction, firstly check
the blood pack labels and the patient’s identity. If there is
any discrepancy, stop the transfusion immediately.
And report the doctor who is responsible and blood bank.
Signs, symptoms and management depend on type of
transfusion reaction.
4
I. Acute transfusion reaction (within 24 hrs)a). Immunologic
1). Haemolytic transfusion reaction
2). Non haemolytic
‐ Febrile non h’lytic transfusion reaction
‐ Allergic (Hypersensitivity) reaction
‐ Anaphylaxis reaction
‐ Transfusion related acute lung injury5
b). Non‐immunologic1). Bacterial contamination and septic
shock2). Heart failure due to fluid overload3). Air Embolism
4). Complication due to massive transfusion
( Acidosis, Hyperkalaemia, Citrate toxicity and
Hypocalcaemia,Depletion of platelets &
coagulation factors, DIC, Hypothermia)
6
II. Delayed transfusion reaction (>24 hrs)a).Immunologic
1).Delayedh’lytic reaction
2).Posttransfusionpurpura
3).GVHD
b).Non‐immunologic
1).Transfusionrelatedinfection
HIV,hepatitisB&C,Syphilic
2).Ironoverload7
Dependonseverity1. Mildreaction‐ mildhypersensitivityreaction
2. Moderatelyseverereaction
‐ moderatelyseverehypersensitivity
‐ febrilenonh’lytic reaction
‐ earlybacterialcontamination
8
III. Severe Life-threatening reactions
‐ h’lytictransfusionraction
‐ bacterialcontaminationandsepticshock
‐ fluidoverload
‐ Anaphylacticreaction
‐ Transfusionrelatedlunginjury
9
I. HYPERSENSITIVITY REACTION
Presenceofantibodyinpatientbloodtotheplasmaproteinofdonorbloodwiththereleaseofhistamine.
Localizedcutaneousreaction(urticaria,rash,pruritus)
10
urticaria
Pruritis 16/03/2010
11
Hpa_an_M
MA
Angioedema
urticaria
urticaria
pruritis
I. HYPERSENSITIVITY REACTION
Mildormoderatelyseverereaction
PreventionInpreviouslyexperiencedpatient give
antihistamineIV30minbeforetransfusion
12
II. FEBRILE NON H’LYTIC TRNSFUSION REACTION
Moderatelyseverity1‐2%
Causedbycytokinereleasedformleucocytesinstoredbloodorpresenceofantibodyinthepatienttoinfusedwhitecells+platelets.
S/Soccur30‐60minsafterthestartoftransfusion
13
II. FEBRILE NON H’LYTIC TRNSFUSION REACTION(FNHTR)
Seenin1.multiparousfemale2.previouslytransfusedpatient3.commoninpatientwithrepeatedbloodtransfusion(AA,Thalassaemia)
Rarelysevere,Butimportanttodifferentiatefromh’lytictransfusionreaction&bacterialcontamination,underlyingcause(malaria).
14
II. FEBRILE NON H’LYTIC TRNSFUSION REACTION
Fever >1*Cabovebaseline earlytransfusionon1‐2hrlater
BacterialContamination >40*C,severerigor hypotension
15
II. FEBRILE NON H’LYTIC TRNSFUSION REACTIONPreventionIfthepatientisaregulartransfusionandhashadtwoormorereactioninthepast.
1).Giveantipyretic(Paracetamol)1hrbeforetransfusion2).Repeat3hrafterthestartoftransfusion3).Transfuseslowly4).Keepthepatientwarm5).Centrifuge+removetheplasmaandbuffy coat6).Ifpossible
‐ Usewashingmethod‐ Usetransfusionsetwithleucocyte filters 16
III. ANAPHYLACTIC REACTION
DuetoantiIgAantibodiesinpatientserumwhichreactwithIgAinthetransfusedblood
PersonwholackIgAintheirserum‐ noprevioushistoryoftransfusion‐ antibodyinserum,reactwithIgA‐ antibodytitreishigh‐ nofever
Passivetransferfromdonor‐ hightitreofAbindonorplasmawhichcanpresent
withinpatientbloodaslongas90days,andreactswithIgApresentinbloodunittransfusedlater. 17
Signs of anaphylaxis
18
IV. FLUID OVERLOAD
‐ Toomuchfluidistransfused
‐ Toorapid
‐ Underlyingdiseasesuchas(RF,Chronicsevere
anaemia,underlyingCVDeg.IHD)
‐ Packedredcells,slowly,diureticsforprevention
19
V. TRANSFUSION RELATED ACUTE LUNGS INJURY( TRALI )
Causedbydonorplasmathatcontainsantibodies
againstthepatientleucocytes.
Donor– multiparouswomen
Within4hroftransfusionacuterespiratory
distress,chestpain,dyspnoea,hypotensio20
V. TRANSFUSION RELATED ACUTE LUNGS INJURY
CXR Bilateralpulmonaryopacity
Nospecifictherapy
RespiratorsupportinICU
Donormustberemovedpermanantly21
(a) Bilateral patchy alveolar infiltrate in TRAL (b) Complete resolution
a b
Criteria for the diagnosis of TRALI• No acute lung injury immediately before transfusion• New acute lung injury:
1. acute onset lung injury, 2. no circulatory overload or PA pressures <18mmHg,3. bilateral pulm infiltrate on Cxr,4. Hypoxemia:Pa02/FiO2 <300, or sat <90% on RA.
• Onset within 6 hours after transfusion • No temporal relation to an alternate risk factor for acute lung injury
Popovsky TP et al TRALI; definition and review. Crit care Med 2005
22
VI. BACTERIAL CONTAMINATION AND SEPTICSHOCK Moderatelysevereorlifethreateningreaction
Bloodmaybecomecontaminatedby1).fromdonorskinduringbloodcollection2).bacteremiaindonoratthetimeofdonation3).defectordamagebloodbag4).improperstorage5).warmingblood6).delayininitiatingbloodtransfusion7).transfusionover>4hr 23
VI. BACTERIAL CONTAMINATION AND SEPTICSHOCK
Usuallysingsandsymptomsappearrapidlyafterstartingtransfusion
HighFever>40*C,rigor,hypotension
HighdoseIVantibiotics
24
VII. MASSIVE OR LARGE VOLUME BLOODTRANSFUSION
<24hr(70ml/kginadult,80‐90ml/kginchild)
Acidosis
Hyperkalaemia
Citratetoxicity+Hypocalcaemia(CitratebindCa*)
Depletionoffibrinogen,coagulationfactors,platelets(<48
hr) Freshfrozenplasmaplateletsrichplasma
Hypothermia25
VII. MASSIVE OR LARGE VOLUME BLOODTRANSFUSION
Microaggragates
Instoredblood,microaggregatesofWBC+platelets
maybepresent.
Inmassivetransfusion,thesemicroaggregatesfuseand
embolizetolungscausingARDS
Prevention Buffycoatdepletedpackedredcells
26
VIII. HAEMOLYTIC TRANSFUSION REACTIONAetiology
I. Bloodgroupincompatibility—
‐mostcasesarecausedbyinfusionofincompatibleredcells.
‐Ab inpatient’splasmareactthecorrespondingantigenon
donorredcellsandcausehaemolysis ofdonorredcells.
‐ABOandRh incompatibility.
‐Sometime,antibodyinpatient’splasmaagainstotherblood
groupantigensoftransfusedblood. 27
VIII. HAEMOLYTIC TRANSFUSION REACTION
II.Transfusionofhaemolysedblood
‐ improperstorage
‐ heating>50*C
‐ contaminationwithorganisms
28
(1 )CAUSES OF BLOOD GROUP INCOMPATIBILITY
I. AvoidableII. Unavoidable
I.Avoidable
Ward Clericalerror
Bloodbank ClericalerrorTechanical error
29
CAUSES OF BLOOD GROUP INCOMPATIBILITY
Ward
‐ Takingbloodfromwrongpatient
‐ Labellingerrorofbloodsamplebottle
‐ Errorsinbloodrequestform
‐ Inadequatechecksofbloodagainstthepatient’s
identity
‐ Givingbloodtowrongpatient30
CAUSES OF BLOOD GROUP INCOMPATIBILITY
BloodBank
‐ wronglabellingbloodbag
‐ errorsingroupingandmatching
‐ errorsinhandlingbloodsample
31
CAUSES OF BLOOD GROUP INCOMPATIBILITY
II.Unavoidable
‐ Transfusionreactionoccurdespiteofcarefulclerical
errorsandtechnicalerrors.
(propertechnique,carefulrecording,interpretation)
‐Duetoverylowlevelofiso‐agglutinationsinrecipient's
serumbelowthesensitivityoftheAgglutinationTest.32
BLOOD GROUP INCOMPATIBILITY
MajorMinor1).Major‐ Destructionofdonorcells‐ Byantibodyinpatient’splasmawhichreactwithAgondonorredcellscells‐ ABOorRhincompatibility‐ maybeduetorareantibodiesofotherbloodgroupsystem
BLOOD GROUP INCOMPATIBILITY
2).Minor‐ Lesssevere‐ Destructionofrecipientcells‐ Byantibodyindonor’splasmawhichreactwithAgonrecipient’sRBC‐ GroupOistransfusedtoarecipientotherthanO(universaldonor)‐ Rarelyseverebutsometimefatal.
BLOOD GROUP SYSTEMS
400antigenonredcellmembraneEachAghasspecificantibodyNaturallyoccuringantibody(IgM)acquiredalloantibody(IgG)
ImmunesystemrecognizeforeignAgandproduceantibodywhenexposetoredcells
COMMON BLOOD GROUP
ABO 1901Rh 1939
Lewis 1946MNS 1927P 1927
Lutheran 1945Kell 1946Kidd 1950Duffy 1951Deigo 1955
Dombrock 1965
I. ABO BLOOD GROUP
ABOAgonRBC
BloodGroup AgonRBC Antibodyinserum
A A BB B AO ‐ A,BAB A,B ‐
I. ABO BLOOD GROUP
PresenceofA,BAgonRBCdependoninheritanceofallelicgeneA,BandO.
Hgeneisfortheprecursorsubstance(H)fromwhichA,BAgareformed.
A,Bgeneproducespecificenzymetransferasewhichaddthespecificsugartoprecursorsubstance(sub:H)andproduceAorBAg.
I. ABO BLOOD GROUPGene Enzyme Addedsugar
A •N‐acetyl‐galactosaminyltransferase
•N‐acetylgalactosamine
B •Galactosyltransferase
•D‐galactose
H •Frucosyl transferase •Fucose
EXPRESSION OF ABH ANTIGEN ON RBC
RBCRBC
H- gene (either HH or Hh) L-fructosyl transferase
B- gene
B- Ag
RBC
RBC
H-substance
A-gene
A- AgSugar N-acetyl galactosamine Sugar- D- galatose
Polysaccharide precursor chain
L-fucose40
I. ABO BLOOD GROUP
Ogeneissilent.So,doesnotalterthestructureofHsubstanceSo,groupOindividualhavelargeamountofHsubstanceonRBCmembrane
Bloodgroup AgA A,HB B,HO HAB A,B,H
I. ABO BLOOD GROUP
BombayBloodGroup SomeindividualsdonotinheritonHgene(hhgenotype).
DonotproduceHsubstance NoAorBAgonRBCmembrane So,bloodgroupO(BombayO) NoHgene noHsubstance antiHantibody IgM,naturallyoccurinantibody Activein37*C
ObloodgrouptobombayO cancauseHTR SoBombayOtoBombayO
I. ABO BLOOD GROUP
Para‐Bombayo SomeindividualsinheritmutantgeneandproducelowlevelofHsubstanceonRBC
o So,HsubstanceiscompletelyusedbyAorBAg
o So,noHAgonRBCo So,antiHantibodyo WeakenthanBombayO
I. ABO BLOOD GROUP
Subgroups AphenotypecanbedividedintoA1andA2dependingonthestructuresofprecursorsubstance(straightchain,branchedchain)
80% A1 AB A1B20% A2 A2B
3%ofA2 antiA1 antibodywhichreactwithA125%ofA2B redcellsAg
A1 toA2withantiA1 HTR(rare) 1activeatlowTemp299% A1 Noclinicalsignificant
II. RH BLOOD GROUP
Ag– D,C,c,E,e DAgismostpotentimmunogen Rh+ve DAg+veRh–ve DAg–ve
70%ofRh–vecanproduceantiDifRh+vebloodisgiven.
C,c,E,eAg antiDAbaftertransfusion
Rh +ve Rh –veDde DceDcE dCeDce dcEDCE dCE
II. RH BLOOD GROUP
Rh Antibody Ig G,alloantibody Occurafterbloodtransfusion,pregnancy Nexttransfusion HTR
WeakD WeakexpressionofDantigen CausenegativereactionwithantiDduringgrpuping
AftertransfusiontoRh –ve patient,causeproductionofantiD
III. OTHER BLOOD GROUPS1).LewisbloodgroupsystemAg– lea,lebphenotype
‐ le(a+b‐)‐ le(a‐b+)‐ le(a‐b‐)‐ le(a+b+)
lewis antibody‐ +inle(a‐b‐)‐ Ig M,naturallyoccuring‐ causeHTRifleAg+blood
III. OTHER BLOOD GROUPS
2).kellsystemAg– K,k,Kp,Jsphenotype– K+k‐,K+k+,K‐k+
‐ Kp(a+b‐),Kp(a+b+),Kp(a‐b+)‐ Js(a+b‐),Js(a+b+),Js(a‐b+)
3).KiddsystemAg– Jka,Jkbphenotype– Jk(a+b‐),Jk(a‐b+),Jk(a+b+),
Jk(a‐b‐)
III. OTHER BLOOD GROUPS
4).DuffysystemAg– Fya,Fybphenotype– Fy (a+b‐)
‐ Fy (a+b+)‐ Fy (a‐b+)‐ Fy (a‐b‐)
5).PbloodgroupsystemAg– P,P1phenotype– P1(P,P1Ag)
‐ P2(onlyPAg)6).Diegosystem
Ag‐Dia,Dib
III. OTHER BLOOD GROUPSANTIBODY
IgGAlloantibodyOccuraftertaransfusionorpregnancyCauseHTRinnexttransfusionPantibody delayedHTR
50
FEATURES OF ACUTE LIFE‐THREATENING TRANSFUSIONREACTIONS
FNHTR Acute IVheamolysis
BacteriaContamination
TRALI Anaphylaxis Fluidoverload
Cause CytokineFromluecoantibody toWBC&platelet
Infusionofincompatibleblood
Skin,bloodpack,thaw,handling
Antibody indonatplasmatopatient’sWBC
1. IgAdeficiency
2. AntibodytoIgA
Toomuch,toorapid(A,Heart,Reanl )
Timing Usuallytowardstheend5‐10% upto2hrsaftertransfusion
50‐100mlofRBCUsua ml)llyrequired
Duringor upto8hraftertransfusion
Within½‐ 4Hrafterstartingoftrnsfusion(10‐15ml)
Early withinaminute
fever + ++ ++ ++ ‐‐ ‐‐
Chills&rigor
++ ++ ++ ++ ‐‐ ‐‐
Hypotension,shock
‐‐ ++ ++ ++ ++ ‐‐51
FEATURES OF ACUTE LIFE‐THREATENING TRANSFUSIONREACTIONS
FNHTR Acute IVhaemolysis
Bacteraicontamination
TRALI anaphylaxis Fluidoverload
S/SofHaemolysis
++,Hburia,Backpain,Coomb’sTest+
DIC ++ ++
Oliguria,Renalfailure
++ + +
Dyspnoea,Respiratorydistress
+ ++ ‐‐ ++,cyanosis++CXR‐diffuseopacity
+airwayobstruction
++
Cutaneous Prutitis,urticaria
GI,N,V + ++ + ‐ NVD.abodminalpain
‐‐
52
SIGNS, SYMPTOMS & MANAGEMENT
I. Mildreactions Signs Symptoms
Mildhypersensitivityreaction
‐Rash‐Urticaria
‐Pruritus‐Itching
53
MANAGEMENT
I.
1).Slowthetransfusion
2).Giveantihistamines(IM)(0.1mg/kg)
3).Continuetransfusionatnormalrateifthereisno
progressionofsymptomsafter30mins
4).Ifnoclinicalimprovementwithinin30minsorif
signsandsymptomsworsen,treatasmoderate
severereaction. 54
SIGNS, SYMPTOMS & MANAGEMENT
II.ModeratelySeverereaction
Signs Symptoms
1.ModeratelysevereH/Sreaction
‐Flushing‐Urticaria
‐Anxiety‐Pruritus
2. FebrilenonH’lytic reaction
‐Rigors‐Fever
‐Palpitation‐Mild dyspnoea
3.Earlybacterialcontamination
‐Restlessness‐Tachycardia
‐Headache55
MANAGEMENTII.
1).Stopthetransfusion.
2).ReplacethegivingsetandkeepIVlinewithN/S.
3).GiveantihistamineIVorIM,oralorrectalantipyretic
(Paracetamol)(500mg– 1ginadult).AVOIDASPIRIN
56
MANAGEMENT
4).GiveIVcorticosteroidandbronchodilationifthere
areanaphylacticfeatures(bronchospasm,stridor).
5).Notifyteamleaderorseniordoctorandblood
bank.
6).Sendthebloodunitwithgivingset,freshly
collectedurineandnewbloodsamples(1clotted
and1anticoagulant)fromtheveinoppositethe
infusionsitewithappropiaterequestformto
bloodbankforinvestigation.57
MANAGEMENT
7).Collecturinefornext24hrforevidenceof
haemolysisandsendtolab.
8).Ifthereisnoclinicalimprovementwithin15minsor
patient’sconditiondeteriorate,treatassevere
reaction.
58
SIGNS, SYMPTOMS & MANAGEMENT
III. SevereLife‐threatening
Signs Symptoms
1. H’lytic transfusionreaction
‐Rigor‐Fever
‐Anxiety‐Chest pain
2. Bacterialcontaminationandsepticshock
‐Restlessness‐Hypotension
‐Painneartheinfusionsite‐Respiratorydistress
3.Fluidoverload ‐Tachycardia ‐Loin/Backpain4.Anaphylacticreaction
‐Hburia ‐Headache
5.Tansfusion relatedlunginjury
‐Unexplainedbleeding(DIC)
‐Dyspnoea 59
MANAGEMENT
III.
1).Stopthetransfusion.Replacethegivingsetandkeep
IVlineopenwithnormalsaline.
2).InfusenormalsalinetomaintainsystolicBP(initial
20‐30ml/kg).Ifhypotensionpresent,giveover5
minsandelevatepatient’slegs.60
MANAGEMENT
3).Maintainairwayandgivehighflowoxygenbymask.
4).Give1:1000Adrenaline0.01mg/kgbodywtbyIM.
5).GiveIVCorticosteroidandbronchodilatorsifthereare
anaphylacticfeatures(bronchospasm,stroidor).
61
Source: Bmj.com
62
MANAGEMENT
6).Givediuretics:eg.Frusemide1mg/kgIVtoprevent
renalfailure.
7).Notifythedoctorresponsibleforthepatientand
bloodbankimmediately.
63
MANAGEMENT
8).Reassessifhypotensionpresent,
‐ givefurthersaline20‐30ml/kgIVover5min
‐ giveinotropesupportofcirculation.
dopamine,dobutamineinfusionandadrenaline1:1000by
IMinjection(0.01mg/kg)
9).AssessforbleedingfrompuncturesiteorwoundforDIC.If
present,givePRPorFFP.Monitorregularlycoagulation
statusofpatient.64
MANAGEMENT
10).IfurineoutputfallorlabevidenceifARF(Ur,Cr,K+),
TreatasARF.
11).Ifbactiraemiaissuspected,bloodspectrumAntibiotics
IV.
12).CheckfirstsampleofurineforsignofHburiaandcollect
24hrurine.
13).Intake– outputchart.
65
INVESTIGATION IN ACUTE TRANSFUSIONREACTION
1).Record
a).Typeoftransfusionreaction
b).Lengthoftimeafterstartoftransfusionthatthe
reactionoccur
c).Volume,typeandnumbersofbloodproducts
transfusion.
66
INVESTIGATION IN ACUTE TRANSFUSIONREACTION2).Takethefollowingsampleandsendthemtotheblood
bankforlaboratoryinvestigation.
a).Immediateposttransfusionsamples(1clottedand1
anticoagulatedEDTA)fromtheveinoppositetheinfusion
sitefor
‐ fullbloodcount
‐ coagulationscreen
‐ directantiglobulintest(DAT)
‐ Urea,Creatinine,Electrolytes
67
INVESTIGATION IN ACUTE TRANSFUSIONREACTION
b).Forbloodcultureinbloodculturebottle
c).Bloodunitandgivingsetcontainingredcellsand
plasmaresiduesfromtransfuseddonorblood.
d).Firstspecimenofpatient’surine
68
INVESTIGATION IN ACUTE TRANSFUSIONREACTION
3).12hrand24hrafterthestartofreaction,giveblood
samples(1clottedand1antigoaulated)fromvein
oppositetheinfusionsite.
4).Patient’s24hrurinesample.
69
MONITORING THE TRANSFUSED PATIENT
1).Foreachunitofbloodtransfusion,monitoratthefollowingstage
‐ Beforestartingthetransfusion
‐ Assoonastransfusionstarted
‐ 15minaftertransfusion
‐ Atleasteveryhourduringtransfusion
‐ Oncompletionoftransfusion
‐ 4hraftertransfusion 70
MONITORING THE TRANSFUSED PATIENT
2).Ateachofthesestages,recordthefollowingonthepatientchart
‐ generalappearance
‐ temperature
‐ BP
‐ pulse
‐ respiratoryrate
‐ urineoutput 71
MONITORING THE TRANSFUSED PATIENT
3).Record
‐ Timeoftransfusionstarted
‐ Timeoftransfusioncompleted
‐ Volumeandtypeofallproducts
transfused
‐ Anyadverseaffected.
72
DELAYED TRANSFUSION REACTION
1).Delayedhaemolyticreaction
‐ patienthaspreviouslyimmunizedtoredcellsAg
duringpregnancyorprevioustransfusion,buthas
lowlevelofantibody.
‐ Afterrepeatedtransfusion,rapidsecondaryimmune
responseandraisedantibodylevelandcause
haemolysis. 73
DELAYED TRANSFUSION REACTION
1).Delayedhaemolyticreaction
‐ Fever,Anaemia,Jaundice,Hburiaafter5– 10days.
‐ Usuallynotreatment.
‐ Treatonlyifhypotensionandrenalfailure.
74
DELAYED TRANSFUSION REACTION2).Posttransfusionpurpura
‐ Female
‐ rarebutpotentiallyfatal
‐ Abagainsttheplateletsinrecipient
‐ severethrombocytopenia5‐10daysaftertransfusion
‐ bleeding,reducedPC<100*109 /L
‐ Highdosesteroid
‐ PRP 75
DELAYED TRANSFUSION REACTION‐ GVHD
3).GVHD‐ rarebutpotentiallyfatal‐ Immunodeficientpatient(drugs,diseases,BMtype)‐ BloodfromdonorwithcompatibleHLAgene‐ DonorTlymphocytesproliferateandattachtherecipienttissue.‐ Fever,skinrash,desquamation,diarrhoea,hepatitis,pancytopenia.‐NospecificTx,onlysupportive
Bonemarrowaplasiaistheprimarycauseofdeath 76
CLINICAL PRESENTATIONSkin: Swollen,erythrodermaandbullaeformation‐most
commonGI: DiarrheaandabdominalcrampsLiver: ElevatedLFTandHyperbilirubinemiaHeme: Bonemarrowaplasia,persistentthrombocytopenia
Skin manifestation of GVHD Generalized swelling, erythroderma and bullous formation
77
Signs/symptoms of Acute Transfusion ReactionGeneral feeling unwell, nausea, fever. Chills, rigors, glushing, urticaria, tachycardia, hyperor
hypotension, collapse, bone/muscle/chest/abdominal pain, shortness of breath, respiratory distress
Stop the transfusion and call a doctorCheck Temp, PR, BP, RR, 02sat, Check the identity of the
patient, blood pack and Issue form
Mild fever and urticarial rash
only
FNHTRIf T rise <1.5*C, stable vital signs, otherwise well, paracetamol 0.5 to 1G,Restart infusion slower rate, observe more frequently
Mild Allergic Reaction
Chlorpheniramine 10mg IVRestart transfusion at slower rate & observe
more frequently
Suspect Severe Reaction
Rigors, fever>1.5*C, restlessness, chest/loin
pain, pain at the infusion site, BP low >20% in
systolic BP, tachycardia( ^ 20% in HR),
haemoglobinuria, unexplained bleeding (DIC)
Fluid Overload, stop infusion, O2, frusemide IV
40-80mg)
NO
URTICARIA FEVER
LOINPAIN,Hburia,DIC
Bronchospasm,angioedema,
abdominalpain,lowBP
SEVERE ANAPH-YLAXIS DYSPNOEA,
Ri‐ JVP
Acutedyspnoea,Cyanosis,JVP not
raised,CXR‐ bilateralinfiltrate
TRALITreat as ARDS, ventilation support
Highfever,rigor,lowBP,nomismatched
Bacteria contamination
Initial Mx of Acute Transfusion Reaction
Recheck blood pack, patient
ID/documentation-ABO
imcompatibility?
78
79
