Transfusion Reaction

Definition | Types | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

A transfusion reaction is an adverse response to the administration of blood products. These reactions can range from mild allergic reactions to severe, life-threatening conditions.

Types

Transfusion reactions can be classified into several types:

  • Acute haemolytic transfusion reaction (AHTR): Caused by ABO incompatibility.
  • Delayed haemolytic transfusion reaction (DHTR): Occurs days to weeks after transfusion due to anamnestic response to red cell antigens.
  • Febrile non-haemolytic transfusion reaction (FNHTR): Caused by cytokines or antibodies reacting with white blood cells.
  • Allergic reaction: Typically mild, caused by plasma proteins.
  • Anaphylactic reaction: Severe allergic reaction, often related to IgA deficiency.
  • Transfusion-related acute lung injury (TRALI): Caused by donor antibodies reacting with recipient white cells.
  • Transfusion-associated circulatory overload (TACO): Volume overload from rapid transfusion.
  • Septic reaction: Due to bacterial contamination of the blood product.

Aetiology

The aetiology of transfusion reactions depends on the type:

  • AHTR: ABO or other blood group incompatibility.
  • DHTR: Anamnestic response to previously encountered red cell antigens.
  • FNHTR: Cytokines or anti-leucocyte antibodies in the donor blood.
  • Allergic reactions: Reaction to plasma proteins in the donor blood.
  • TRALI: Donor anti-leucocyte antibodies reacting with recipient white cells.
  • TACO: Excessive blood volume transfused rapidly.
  • Septic reaction: Bacterial contamination of the blood product.

Pathophysiology

The pathophysiology varies with each type of transfusion reaction:

  • AHTR: Complement activation and haemolysis due to ABO incompatibility.
  • DHTR: Haemolysis caused by reactivation of antibodies to red cell antigens.
  • FNHTR: Release of cytokines or reaction of antibodies with donor white cells.
  • Allergic reactions: IgE-mediated reaction to plasma proteins.
  • TRALI: Immune reaction causing capillary leakage in the lungs.
  • TACO: Volume overload leading to pulmonary oedema.
  • Septic reaction: Bacterial toxins causing systemic infection.

Risk Factors

  • Previous transfusions
  • Multiple pregnancies (alloimmunisation risk)
  • Underlying immunological conditions
  • Chronic anaemia
  • Rapid or large volume transfusions
  • IgA deficiency

Signs and Symptoms

Common signs and symptoms of transfusion reactions include:

  • Fever and chills
  • Hypotension
  • Urticaria or rash
  • Dyspnoea
  • Loin pain
  • Haemoglobinuria
  • Jaundice
  • Chest pain
  • Acute respiratory distress

Key Examination Findings

During physical examination, look for:

  • Fever
  • Hypotension or hypertension
  • Skin reactions (rash, urticaria)
  • Tachycardia
  • Respiratory distress signs (e.g., wheezing, cyanosis)
  • Loin or back pain
  • Signs of shock (cold, clammy skin)

Investigations

Specific blood tests and investigations include:

  • Full blood count (FBC): To check for haemolysis and changes in haematocrit.
  • Direct antiglobulin test (DAT): To detect antibodies attached to red blood cells in haemolytic reactions.
  • Blood cultures: To identify bacterial contamination in septic reactions.
  • Renal function tests (U&Es): To assess kidney function, especially in haemolytic reactions.
  • Liver function tests (LFTs): To check for liver involvement.
  • Coagulation profile: To assess for disseminated intravascular coagulation (DIC).
  • Chest X-ray: To identify pulmonary complications like TRALI or TACO.
  • Serum haptoglobin: Decreased levels indicate haemolysis.
  • Lactate dehydrogenase (LDH): Elevated levels indicate cell destruction.
  • Serum bilirubin: Elevated indirect bilirubin indicates haemolysis.

Management

Primary Care Management

  • Immediate cessation of transfusion: Stop the transfusion at the first sign of a reaction.
  • Supportive care: Maintain airway, breathing, and circulation. Administer oxygen if needed.
  • Initial stabilisation: Ensure IV access, monitor vital signs, and provide fluids if necessary.
  • Referral to hospital: Urgent referral to a secondary care facility for further management.

Specialist Management

  • Acute haemolytic transfusion reaction:
    • Stop transfusion immediately.
    • Maintain IV access with normal saline.
    • Administer supportive care (oxygen, fluids, vasopressors if needed).
    • Monitor for signs of renal failure and disseminated intravascular coagulation (DIC).
  • Febrile non-haemolytic transfusion reaction:
    • Stop transfusion and provide antipyretics (e.g., paracetamol).
    • Monitor patient and restart transfusion```html restart when symptoms resolve.
  • Allergic and anaphylactic reactions:
    • Stop transfusion immediately.
    • Administer antihistamines (e.g., chlorphenamine).
    • Provide corticosteroids (e.g., hydrocortisone) for severe reactions.
    • Administer adrenaline for anaphylaxis.
  • Transfusion-related acute lung injury (TRALI):
    • Stop transfusion immediately.
    • Provide supportive care with oxygen therapy.
    • Monitor in an intensive care setting if needed.
  • Transfusion-associated circulatory overload (TACO):
    • Stop transfusion immediately.
    • Administer diuretics (e.g., furosemide).
    • Provide supportive care with oxygen therapy.
    • Monitor fluid balance and electrolytes.
  • Septic reaction:
    • Stop transfusion immediately.
    • Administer broad-spectrum antibiotics.
    • Provide supportive care with fluids and vasopressors if needed.

References

  1. NHS. (2024). Blood Transfusions - Adverse Effects. Retrieved from NHS
  2. British Society for Haematology. (2024). Guidelines on the Management of Transfusion Reactions. Retrieved from BSH
  3. UK Blood Transfusion and Tissue Transplantation Services. (2024). Management of Acute Transfusion Reactions. Retrieved from UK Blood Transfusion Services

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