Transfusion Reaction

Question 1

Pre-formed antibodies attack donor RBCs → intravascular hemolysis

Answer 1

Acute Hemolytic Transfusion Reaction (AHTR)

Question 2

Usually due to ABO mismatch (clerical/system error)

Answer 2

Acute Hemolytic Transfusion Reaction (AHTR)

Question 3

Clinical features of Acute Hemolytic Transfusion Reaction (AHTR)

Answer 3

 Fever, chills, flank pain, dark urine
 Jaundice (↑ bilirubin)
 Can progress to DIC → oozing from IV sites
 Positive Direct Antiglobulin Test (DAT) (indicates RBC-bound antibodies)

Question 4

Acute Hemolytic Transfusion Reaction (AHTR) Occurs ……………

Answer 4

during transfusion or within 24 hours

Question 5

Management of AHTR

Answer 5

 Stop transfusion immediately
 IV fluids to prevent acute kidney injury
 Oxygen, vasopressors if needed

Question 6

Antibodies to minor RBC antigens

Answer 6

Delayed Hemolytic Transfusion Reaction

Question 7

Occurs days to weeks after transfusion (delayed immune response)

Answer 7

Delayed Hemolytic Transfusion Reaction

Question 8

Clinical features of Delayed Hemolytic Transfusion Reaction

Answer 8

 Fever, mild hemolysis
 Positive Direct Antiglobulin Test (DAT)

Question 9

Management of Delayed Hemolytic Transfusion Reaction

Answer 9

Supportive care (no specific treatment)

Question 10

IgA-deficient patients who develop anti-IgA antibodies

Answer 10

Anaphylactic Transfusion Reaction

Question 11

Reaction to plasma proteins in transfused blood

Answer 11

Anaphylactic Transfusion Reaction

Question 12

Clinical Features of Anaphylactic Transfusion Reaction

Answer 12

 Occurs seconds to minutes after transfusion begins
 Urticaria, angioedema, wheezing
 Severe cases: Hypotension, shock

Question 13

Management of Anaphylactic Transfusion Reaction

Answer 13

 Stop transfusion immediately
 Epinephrine
 Antihistamines (diphenhydramine), corticosteroids if needed

Question 14

Plasma proteins in transfused blood

Answer 14

Urticarial (Allergic) Transfusion Reaction

Question 15

Clinical features of Urticarial (Allergic) Transfusion Reaction

Answer 15

 Hives (urticaria) only
 NO wheezing, hypotension, or angioedema

Question 16

Management of Urticarial (Allergic) Transfusion Reaction

Answer 16

 Stop transfusion
 Diphenhydramine
 Transfusion may be restarted if urticaria resolves

Question 17

Cytokines released by WBCs in stored blood products

Answer 17

Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

Question 18

More common in non-leukoreduced blood

Answer 18

Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

Question 19

Clinical features of Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

Answer 19

 Fever, chills
 No hemolysis, normal blood pressure
 No signs of infection

Question 20

Management of Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

Answer 20

 Stop transfusion
 Give acetaminophen (antipyretic)

Question 21

Neutrophil activation by transfused blood products

Answer 21

Transfusion-Related Acute Lung Injury (TRALI)

Question 22

Inflammation → lung capillary damage → pulmonary edema

Answer 22

Transfusion-Related Acute Lung Injury (TRALI)

Question 23

Non-cardiogenic pulmonary edema (exudative)

Answer 23

Transfusion-Related Acute Lung Injury (TRALI)

Question 24

Clinical features of Transfusion-Related Acute Lung Injury (TRALI)

Answer 24

 Occurs minutes to hours after transfusion
 Hypoxemic respiratory failure
 Chest X-ray: Bilateral pulmonary edema
 Hypertension (unlike anaphylaxis)

Question 25

Management of Transfusion-Related Acute Lung Injury (TRALI)

Answer 25

 Stop transfusion  Oxygen + respiratory support  No antibiotics or diuretics needed  Resolves with time

Question 26

Volume overload due to rapid blood transfusion

Answer 26

Transfusion-Associated Circulatory Overload (TACO)

Question 27

More common in elderly, heart failure patients

Answer 27

Transfusion-Associated Circulatory Overload (TACO)

Question 28

Clinical features of Transfusion-Associated Circulatory Overload (TACO)

Answer 28

 Hypoxemic respiratory failure after transfusion  Pulmonary edema (cardiogenic)  ↑ JVP, S3 heart sound, ↑ BNP  Hypertension

Question 29

Management of Transfusion-Associated Circulatory Overload (TACO)

Answer 29

 Stop transfusion  Diuretics (furosemide)  Oxygen and ventilatory support

Question 30

Bacterial contamination of transfused blood

Answer 30

Transfusion-Transmitted Bacterial Infection (TTBI)

Question 31

Clinical features of ransfusion-Transmitted Bacterial Infection (TTBI)

Answer 31

 Fever, chills  Septic shock (hypotension, tachycardia)

Question 32

Management of ransfusion-Transmitted Bacterial Infection (TTBI)

Answer 32

 Stop transfusion  Blood cultures  Start IV antibiotics