PRBC transfusion

Question 1

Risks

Answer 1

Transfusion reactions- extremely rare- mostly due to clerical error

Even rarer in exsanguinating pts- likely due to alterations in immune system caused by the injury needing massive transfusion.

Question 2

Early adverse reactions

Answer 2

EARLY

1.TACO (transfusion associated circulatory overload)
2.TRALI (transfusion related acute lung injury)
3.haemolytic reactions (incompatibility – ABO, Rh, Kidd)
4.fever
5.allergy (mild -> anaphylaxis)
6.infection: bacterial contamination
7.air embolism
8.hypothermia

Question 3

Late complications

Answer 3

1.viral infection: hepatitis B (~1 in 750,000), HIV (<1 in a million), CMV
2.bacterial infection: Treponema pallidum, Salmonella, Yersinia, Pseudomonas, Staphylococcus spp
3.parasitic infection: malaria (<1 in a million), toxoplasmosis
4.prion infection
5.GVHD (graft versus host disease)
6.immune sensitisation (Rh D antigen)
7.TRIM (transfusion-related immunomodulation); leading to increased risk of: infection, tumour recurrence, activation of latent viral infections, recurrent miscarriages

Question 4

TRALI

Answer 4

Noncardiogenic pulmonary oedema that occurs within 4-6hrs post transfusion
More of a localised pulmonary inflammation

Most common following Plasma transfusion.

Question 5

TRIM

Answer 5

TRALI and TRIM likely variants of same disorder-
Exaggerated inflammatory response and damaged immune system.

Represents systemic immune derangement

Mech:
Cotransfusion of soluble proteins eg- FDPs, HLA, disrupted WBCs all implicated.

Best exemplified by reports showing increased incidence of infection following transfusion of PRBC