acute immunologic effects
hemolytic transfusion reactions
mediators: IgM A/B (usually ABO), complement
s/s fever,chills, hemoglobinemia, hemoglobuninuria, hypotension, dyspnea
decrease opportunities for area treat ARF and DIC
TRALI - transfusion related acute lung injury
occurs within the 1st 6 hrs following a transfusion
typically associated with plasma components - platelets and FFP
mortality rate ranges from 5-25% with most patients recovering in 72 hrs
tx: ECMO
bacterial contamination
endotoxins produced by GN bacteria
s/s fever, shock, hemoglobinuria
treatment: IV ABX, treat hypotension and DIC
hemolytic transfusion
mediators: IgG A/B
shortened RBC survival, decreased hemoglobin, fever, jaundice, hemoglobinuria
tx: Ig-negative blood for further transfusions
transfusion induced hemosideroisis
MOA: iron overload
subclincal to death
decrease transfusion frequency, neocytes, and iron chelation therapy
* seen in anemia, sickle cell, ESRD, clotting deficiencies
nonhemolytic febrile transfusion reactions
mediators to A/B to HLA class I ag
s/s fever and chills
treatment/prevention: antipyretics, leukocyte reduced
criteria for trali
acute onset hypoxemia
PaO2/FIO2 ratio < 300
SpO2 < 90% on room air
Bilateral diffuse pulmonary infilitrates
no evidence of LA HTN (circulatory overload)
circulatory overload (TACO)
fluid volume
coughing, cyanosis, orthopnea, severe headache, peripheral edmea, difficulty breathing
treatment: administer tx slowly and in small volume
treat symptoms - reduce volume give concentrated
transfusion associated graft vs host disease
mediators: viable donor lymphocytes
fever, skin rash, desquamation, anorexia, nausea, vomiting, diarrhea, hepatitis, pancytopenia
treatment: gamma irridation of cellular components
Class I hemorrhage
blood loss up to 750 mL
15% blood volume loss
P < 100 bpm, BP normal, PP normal or increased, RR 14-20, UOP > 30 mL/hr, slightly anxious, crystalloid replacement
allergic transfusion reactions
mediators: plasma proteins (mild reactions), A/B to IgA (anaphalytic reactions)
s/s: urticaria, erythema, itching, anaphylaxis
treatment: antihistamines, treat symptoms, transfuse IgA dficient components
immediate management of TRALI
stop transfusion immediately
support the patient
CBC/CXR
notifify blood bank & quarantine donor
hemolysis due to physical and chemical means
exogenous destruction of RBCs
s/s hemoglinuria
rule out hemolysis due to other causes; treat DICpost transfusion purpura
Thrombocytopenia & clinical bleedig
tx: IVIG, plasma exchange, corticosteroids
Class II hemorrhage
750-1500 mL
blood volume loss 15-30 %
Pulse > 100, normal BP, decreased PP, RR: 20-30, UOP 20-30 ml/hr, mildly anxious, crystalloid
noncardiogenic pulmonary transfusion reaction
mediators: donor/reciepents WBC A/B
s/s: ARDS, fever, chills, cyanosis. hypotension, noncardiogenic Pulmonary edema
treatment: PEEP, steroids
TRALI VS TACO
trali - fever hypotension, acute dyspnea, JVP no change, ausculatation- rales, xray - bilateral infiltrates, EF normal, response to duiretic minimal
taco - no fever, hypertension, acute dyspnea, JVP can be changes, rales + S3, diffuse bilateral infiltrates, decreased EF, improvement with diuretic
hypocalcemia and transfusions
citrate is metabolized in the liver
hemorrhage leads to hypothermia and decreased iCa++
hypocalcemia is due to chelation of serum calcium and citrate
Ca++Gluc << Ca++Chloride
Ca++ gluc contains 90 mg of elemental calcium
Ca++ chloride contains 270 mg of elemental calcium
female of child bearing age
*Rh+ blood= product of choice for males
Class III hemorrhage
1500-2000 mL blood loss
30-40% blood volume loss
Pulse > 120, decreased BP, decreased PP, RR: 30-40, UOP: 5-15 mL/hr, anxious, confused, crystalloid and blood
steps followed after any reaction
DC transfusion
keep the IV line open
check labels, forms, and pt ID
report to blood bank
send blood samples
MTP in adults and children
adults - total blood volume is replaced in 24 hr
50% replaced in 3 hours
children = > 40 mL/kg transfusion
1:1:1 ratio (platelets:plasma:RBCs)
WB dosing
30 mL/kg
which product increases fibrinogen levels the most
LTOWB - 1000 mg
FFP - 400 mg
Cryo - 2500 mg
Class IV hemorrhage
> 2000 mL
> 40 % blood loss
Pulse > 140, decreased BP, decreased PP, RR> 35, confused/lethargic, crystalloid and blood