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The Resident on Duty decided totransfuse the patient with 2 units ofpacked red blood cells (PRBCs)
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PRBC
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Immune-Mediated Reactions
Acute Hemolytic Transfusion Reactions
preformed antibodies that lyse donorerythrocytes.
The ABO isoagglutinins are responsible
for the majority of these reactions
Acute hemolytic reactions may present
hypotension
tachypnea
tachycardia
Fever chills
hemoglobinemia
hemoglobinuria
chest and/or flank pain
discomfort at the infusion site
Errors at the patient's bedside, such asmislabeling the sample or transfusing
the wrong patient
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AnaphylacticReaction
immediate hypersensitivitytype of immune system
response
mild urticaria (hives) and
pruritus to severe shock anddeath
Symptoms and signs includedifficulty breathing,
coughing, nausea and
vomiting, hypotension,bronchospasm, loss of
consciousness, respiratoryarrest, and shock
IgA deficiency
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Febrile Nonhemolytic Transfusion
Reaction (FNHTR)
FNTHR
most frequent reaction associated with thetransfusion of cellular blood components
characterized by chills and rigors and a 1C rise intemperature.
The leukocyte antibodies are commonly directedagainst antigens present on monocytes,
granulocytes,or lymphocytes
diagnosed when other causesof fever in the transfused
patient are ruled out.
Antibodies directed against donor leukocyte andHLA antigens may mediate these reactions
American Association of Blood Banks(AABB)Technical Manualdefines FNHTR as a 1C
temperature rise associated with transfusion andhaving no medical explanation other than blood
component transfusion
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acute respiratory distress,either during or within 6 h
of transfusing the patient. characterized by chills,
cough, fever, cyanosis,hypotension, andincreasing respiratory
distress shortly aftertransfusion of bloodcomponent volumes thatusually do not producehypervolemia
leukocyte antibodies indonor or patient plasma
Transfusion-
RelatedAcute Lung
Injury
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Nonimmunologic Reactions
fever and chills,which can progress toseptic shock and DIC.
(CDC), most arecaused by bloodcomponentscontaminated byYersinia enterocolitica
BacterialContamination
Reactions appear rapidly during
transfusion or withinabout 30 minutesafter transfusion
this type of reactionis termed warm andis characterized bydryness and flushingof the patients skin
Clinical signsand symptoms
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(transfusion-associated circulatory
overload, TACO) Blood components are excellent volume
expanders
-> Fluid overload
iatrogenic (physician-caused) transfusion
reaction. congestive heart failure and pulmonary
edema
dyspnea, coughing, cyanosis, orthopnea,chest discomfort, headache, restlessness,tachycardia, systolic hypertension (greaterthan 50mmHg increase), and abnormalelectrocardiogram results.
FluidOverload
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Electrolyte Toxicity
RBC leakage during storage increases theconcentration of potassium in the unit.
Citrate, commonly used to anticoagulateblood components
Hypocalcemia
manifested by circumoral numbness and/ortingling sensation of the fingers and toes,may result from multiple rapid transfusions.
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Hypothermia
Refrigerated(4C) or frozen (18C or below)
bloodcomponents
rapidly infused
Cardiacdysrhythmias