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Blood Transfusion Reaction and Management

blood transfusion reactions types

blood transfusion reactions

 

Blood transfusion reactions are the reactions result with fever, chills, pruritus seen that occur within the 24 hours of a blood transfusion which can be resolve normally. The other  blood transfusion reaction include severe shortness of breath, reddish urine , high fever, or loss of consciousness are the sign of  severe fatal reaction.

The Following are the types of  Blood Transfusion Reactions:

Allergic Reaction:

This complication of blood transfusion is caused by sensitivity to plasma protein of donor antibody, which reacts with recipient antigen. These reactions are usually due to hypersensitivity to allogeneic proteins in plasma, on leukocytes or platelets or, uncommonly, soluble allergens found in the transfused blood component. Allergic reactions typically present as  flusing, rash, urticaria, or pruritus and laryngeal edema and difficulty of breathing .Allergic reactions are IgE mediated but if anaphylatic recations  it is associated with anti-IgA in recipients who are IgA deficient. However, anaphylactic reactions occur, uncommonly.

Febrile, Non-Hemolytic Reactions:

This transfusion reaction is caused by hypersensitivity to donor white cells, platelets or plasma proteins . They are usually caused by cytokines from leukocytes in transfused red cell or platelet components, causing fever, chills, or rigors. This is the most symptomatic complication of blood transfusion. During the reaction, there is temperature elevation of 1º C or 2º F. The sympotms are usually  Sudden chills and fever, Flushing, Headache, Anxiety

Hemolytic Reaction:

Acute hemolytic transfusion reactions is caused by infusion of incompatible blood products. Generally it is due to immune or nonimmune-mediated reactions.  Immune-mediated  reactions are caused by immunoglobulin M (IgM) anti-A, anti-B, or anti-A,B  which typically result in severe conditions that are fatal complement-mediated intravascular hemolysis. Immune-mediated hemolytic reactions are caused by IgG, Rh, Kell, Duffy, or other non-ABO antibodies that results in extravascular sequestration that decrease survival of transfused red cells.  this cause mild clinical reactions. 

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The usual signs and symptoms are:

• Low back pain (first sign). This is due to inflammatory response of the kidneys to incompatible blood
• Chills
• Feeling of fullness
• Tachycardia
• Flushing
• Tachypnea
• Hypotension
• Bleeding
• Vascular collapse
• Acute renal failure

 

Transfusion-Related Acute Lung Injury(TRALI)

This complications leads to  actue lung injury . There are two pathophysiologic mechanisms: the antibody hypothesis and the neutrophil priming hypothesis.  Both mechanisms lead to pulmonary embolism leading to circulatory overload.

In antibody hypothesis the human leukocyte antigen (HLA class I, HLA class II) or human neutrophil antigen (HNA) antibody in the transfused component reacts with neutrophil antigens in the recipient. The recipient’s neutrophils lodge in the pulmonary capillaries and release mediators that cause pulmonary capillary leakage. then leads to TRALI thus develop transient leukopenia.  

The next hypothesis is  neutrophil priming hypothesis  that does not require antigen-antibody interactions and occurs in patients with clinical conditions that predispose to neutrophil priming and endothelial activation such as infection, surgery, or inflammation. Bioactive substances in the transfused component activate the primed, sequestered neutrophils, and pulmonary endothelial damage occurs.

Circulatory overload

Circulatory (volume) overload occurs when the volume of the transfused blood components and that of any coincidental infusions cause acute hypervolemia. Typically, this causes acute pulmonary edema. 

Immidiate Interventions for Blood Transfusion Reaction

1. The first thing to do when complications in blood transfusion occurs is to STOP TRANSFUSION.

2. Then start or open I.V. line (0.9%NaCl).

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3. Place the client in fowler’s position and administer oxygen therapy depending in the hospital protocol.

4. Check vital signs  frequently as often as 5 mins.

5. Obtain urine specimen and send to the laboratory to determine presence of hemoglobin as a result of RBC hemolysis.

 

 

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