acute immunologic effects
acute nonimmunologic effects
delayed immunologic effects
delayed nonimmunologic 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


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 DIC


post transfusion purpura

MOA: platelt specific A/b

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 - 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

Rh negative blood to male or female

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