Transfusion reaction: Difference between revisions
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In [[medicine]], a '''transfusion reaction''' is an adverse effect due to [[blood component transfusion]] such as [[erythrocyte transfusion]] or [[platelet transfusion]]. | |||
==Immunologic== | A classification has been proposed by the [http://www.aabb.org/ American Association of Blood Banks (AABB)].<ref name="pmid17381620">{{cite journal |author=Sanders RP, Geiger TL, Heddle N, Pui CH, Howard SC |title=A revised classification scheme for acute transfusion reactions |journal=Transfusion |volume=47 |issue=4 |pages=621–8 |year=2007 |month=April |pmid=17381620 |doi=10.1111/j.1537-2995.2007.01163.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0041-1132&date=2007&volume=47&issue=4&spage=621 |issn=}}</ref> | ||
===Febrile, nonhemolytic transfusion reaction (FNHTR)=== | |||
==Diagnosis== | |||
===History and physical examination=== | |||
Patients with symptoms coincident with a transfusion may have reactions ranging from mild febrile, nonhemolytic transfusion reaction (FNHTR) to life threatening anaphylaxis or hemolysis. Three common [[sign (medical)|signs]] are below and are highlighted to show which types of reactions may underlie the [[sign (medical)| sign]]: | |||
* <span style="background-color:cyan">dyspnea</span> | |||
* <span style="background-color:fuchsia">hypotension</span> | |||
* <span style="background-color:chartreuse">fever</span> | |||
==Management== | |||
If hemolysis is possible, give intravenous fluids and test for repeat [[blood cross-matching]], direct [[Coombs' test]] (cross-matching only includes the indirect Coombs' test), plasma free hemoglobin, and urine hemoglobin. | |||
==Types of reactions== | |||
===Immunologic=== | |||
====Febrile, nonhemolytic transfusion reaction (FNHTR)==== | |||
FNHTR may include temperature elevation > 1°C, chills and/or rigors, headache, vomiting. This is a minor, acute reaction suggested by negative a [[Coombs' test]], no free hemoglobin in the plasma, and no hemoglobin in the urine. | FNHTR may include temperature elevation > 1°C, chills and/or rigors, headache, vomiting. This is a minor, acute reaction suggested by negative a [[Coombs' test]], no free hemoglobin in the plasma, and no hemoglobin in the urine. | ||
===Hemolytic reactions=== | ====Hemolytic reactions==== | ||
Hemolytic reactions due to [[blood group incompatibility]] is "mismatch between donor and recipient blood. [[Antibody|Antibodies]] present in the recipient's serum are directed against [[antigen]]s in the donor product. Such a mismatch may result in a transfusion reaction in which, for example, donor blood is hemolyzed."<ref>{{MeSH|Blood group incompatibility}}</ref> | Hemolytic reactions due to [[blood group incompatibility]] is "mismatch between donor and recipient blood. [[Antibody|Antibodies]] present in the recipient's serum are directed against [[antigen]]s in the donor product. Such a mismatch may result in a transfusion reaction in which, for example, donor blood is hemolyzed."<ref>{{MeSH|Blood group incompatibility}}</ref> | ||
====Acute hemolytic transfusion reactions==== | =====Acute hemolytic transfusion reactions===== | ||
ICD9: {{ICD9|999.6}} | ICD9: {{ICD9|999.6}} | ||
Acute hemolytic transfusion reactions due to ABO incompatibility may show chills, fever, hypotension, renal failure, back pain, hemoglobinuria | Acute hemolytic transfusion reactions due to ABO incompatibility may show chills, <span style="background-color:chartreuse">fever</span>, <span style="background-color:fuchsia">hypotension</span>, renal failure, back pain, hemoglobinuria | ||
====Delayed hemolytic transfusion reactions==== | =====Delayed hemolytic transfusion reactions===== | ||
ICD9: {{ICD9|999.7}} | ICD9: {{ICD9|999.7}} | ||
This reaction usually causes delayed hemolysis. This may be caused by Rh incompatibility. | This reaction usually causes delayed hemolysis. This may be caused by Rh incompatibility. | ||
===Allergic reactions=== | ====Allergic reactions==== | ||
[[ | Type 1 hypersensitivity ([[immediate hypersensitivity]]) reactions include: | ||
* Anaphylactic transfusion reactions may occur, especially in patients with IgA-deficiency and may cause dyspnea | * [[Anaphylaxis|Anaphylactic]] transfusion reactions may occur, especially in patients with IgA-deficiency and may cause <span style="background-color:cyan">dyspnea</span> from bronchospasm, <span style="background-color:fuchsia">hypotension</span>, urticaria. | ||
* Urticaria may occur due to the recipient's IgE reacting to antigens from the donor and cause urticaria, pruritis, and flushing. | * [[Urticaria]] may occur due to the recipient's IgE reacting to antigens from the donor and cause urticaria, pruritis, and flushing. | ||
===Transfusion related acute lung injury (TRALI)=== | ====Transfusion related acute lung injury (TRALI)==== | ||
ICD9: {{ICD9|518.7}} | ICD9: {{ICD9|518.7}} | ||
Transfusion-related acute lung injury (pulmonary leukoagglutinin reaction) (TRALI) is an acute reaction that may include hypoxemia, respiratory failure, hypotension, and fever. | Transfusion-related acute lung injury (pulmonary leukoagglutinin reaction) (TRALI) is an acute reaction that may include <span style="background-color:cyan">dyspnea</span>, hypoxemia, respiratory failure, <span style="background-color:fuchsia">hypotension</span>, and <span style="background-color:chartreuse">fever</span>. | ||
====Posttransfusion purpura==== | |||
Posttransfusion purpura (PTP) is an immune [[thrombocytopenia]]. This is more common in women who have been pregnant. | |||
===Graft-versus-host disease=== | ====Graft-versus-host disease==== | ||
Transfusion associated graft-versus-host disease (TA-GVHD) is when the donor's blood attacks the recipient's body. | Transfusion associated graft-versus-host disease (TA-GVHD) is when the donor's blood attacks the recipient's body. | ||
==Nonimmunologic== | ===Nonimmunologic=== | ||
===Nonimmune hemolysis=== | ====Nonimmune hemolysis==== | ||
Nonimmune hemolysis may be due to physical destruction of donor blood from heating or freezing. | Nonimmune hemolysis may be due to physical destruction of donor blood from heating or freezing. | ||
===Chemical reactions=== | ====Chemical reactions==== | ||
* Hemosiderosis | * Hemosiderosis | ||
* Hypocalcemia from citrate toxicity | * Hypocalcemia from citrate toxicity | ||
| Line 39: | Line 55: | ||
* Metabolic alkalosis and hypokalemia due to citrate | * Metabolic alkalosis and hypokalemia due to citrate | ||
===Transmission of infection=== | ====Transmission of infection==== | ||
Transfusion associated sepsis may manifest 'fever > 40°C and/or cardiovascular collapse.'<ref name="pmid17381620">{{cite journal |author=Sanders RP, Geiger TL, Heddle N, Pui CH, Howard SC |title=A revised classification scheme for acute transfusion reactions |journal=Transfusion |volume=47 |issue=4 |pages=621–8 |year=2007 |month=April |pmid=17381620 |doi=10.1111/j.1537-2995.2007.01163.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0041-1132&date=2007&volume=47&issue=4&spage=621 |issn=}}</ref> | {{ICD9|999.39}} | ||
Transfusion associated sepsis may manifest '<span style="background-color:chartreuse">fever</span> > 40°C and/or cardiovascular collapse.'<ref name="pmid17381620">{{cite journal |author=Sanders RP, Geiger TL, Heddle N, Pui CH, Howard SC |title=A revised classification scheme for acute transfusion reactions |journal=Transfusion |volume=47 |issue=4 |pages=621–8 |year=2007 |month=April |pmid=17381620 |doi=10.1111/j.1537-2995.2007.01163.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0041-1132&date=2007&volume=47&issue=4&spage=621 |issn=}}</ref> | |||
===Other reactions=== | ====Other reactions==== | ||
* Air embolus may manifest 'sudden dyspnea, cyanosis, chest pain, cough, hypotension, cardiac arrhythmia.'<ref name="pmid17381620">{{cite journal |author=Sanders RP, Geiger TL, Heddle N, Pui CH, Howard SC |title=A revised classification scheme for acute transfusion reactions |journal=Transfusion |volume=47 |issue=4 |pages=621–8 |year=2007 |month=April |pmid=17381620 |doi=10.1111/j.1537-2995.2007.01163.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0041-1132&date=2007&volume=47&issue=4&spage=621 |issn=}}</ref> | * Air embolus may manifest 'sudden <span style="background-color:cyan">dyspnea</span>, cyanosis, chest pain, cough, <span style="background-color:fuchsia">hypotension</span>, cardiac arrhythmia.'<ref name="pmid17381620">{{cite journal |author=Sanders RP, Geiger TL, Heddle N, Pui CH, Howard SC |title=A revised classification scheme for acute transfusion reactions |journal=Transfusion |volume=47 |issue=4 |pages=621–8 |year=2007 |month=April |pmid=17381620 |doi=10.1111/j.1537-2995.2007.01163.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0041-1132&date=2007&volume=47&issue=4&spage=621 |issn=}}</ref> ICD9: {{ICD9|999.1}} | ||
* Hypothermia | * Hypothermia | ||
* Circulatory overload may cause dyspnea. | * Circulatory overload may cause <span style="background-color:cyan">dyspnea</span>. | ||
* Hypotension associated with leukoreduced blood and [[angiotensin-converting enzyme]] may cause flushing and hypotension. | * Hypotension associated with leukoreduced blood and maybe [[angiotensin-converting enzyme]] may cause flushing and <span style="background-color:fuchsia">hypotension</span>. | ||
==References== | ==References== | ||
| Line 52: | Line 69: | ||
==External links== | ==External links== | ||
* [http://www.aabb.org/ American Association of Blood Banks (AABB)] | |||
* [http://www.isbt-web.org/ International Society of Blood Transfusion (ISBT)] | * [http://www.isbt-web.org/ International Society of Blood Transfusion (ISBT)] | ||
* Dean L. (2005) [http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=rbcantigen Blood Groups and Red Cell Antigens] NCBI | * Dean L. (2005) [http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=rbcantigen Blood Groups and Red Cell Antigens] NCBI | ||
** [http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=rbcantigen&part=ch3 Blood transfusions and the immune system] | ** [http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=rbcantigen&part=ch3 Blood transfusions and the immune system] | ||
Latest revision as of 21:57, 14 February 2010
In medicine, a transfusion reaction is an adverse effect due to blood component transfusion such as erythrocyte transfusion or platelet transfusion.
A classification has been proposed by the American Association of Blood Banks (AABB).[1]
Diagnosis
History and physical examination
Patients with symptoms coincident with a transfusion may have reactions ranging from mild febrile, nonhemolytic transfusion reaction (FNHTR) to life threatening anaphylaxis or hemolysis. Three common signs are below and are highlighted to show which types of reactions may underlie the sign:
- dyspnea
- hypotension
- fever
Management
If hemolysis is possible, give intravenous fluids and test for repeat blood cross-matching, direct Coombs' test (cross-matching only includes the indirect Coombs' test), plasma free hemoglobin, and urine hemoglobin.
Types of reactions
Immunologic
Febrile, nonhemolytic transfusion reaction (FNHTR)
FNHTR may include temperature elevation > 1°C, chills and/or rigors, headache, vomiting. This is a minor, acute reaction suggested by negative a Coombs' test, no free hemoglobin in the plasma, and no hemoglobin in the urine.
Hemolytic reactions
Hemolytic reactions due to blood group incompatibility is "mismatch between donor and recipient blood. Antibodies present in the recipient's serum are directed against antigens in the donor product. Such a mismatch may result in a transfusion reaction in which, for example, donor blood is hemolyzed."[2]
Acute hemolytic transfusion reactions
ICD9: 999.6
Acute hemolytic transfusion reactions due to ABO incompatibility may show chills, fever, hypotension, renal failure, back pain, hemoglobinuria
Delayed hemolytic transfusion reactions
ICD9: 999.7
This reaction usually causes delayed hemolysis. This may be caused by Rh incompatibility.
Allergic reactions
Type 1 hypersensitivity (immediate hypersensitivity) reactions include:
- Anaphylactic transfusion reactions may occur, especially in patients with IgA-deficiency and may cause dyspnea from bronchospasm, hypotension, urticaria.
- Urticaria may occur due to the recipient's IgE reacting to antigens from the donor and cause urticaria, pruritis, and flushing.
ICD9: 518.7
Transfusion-related acute lung injury (pulmonary leukoagglutinin reaction) (TRALI) is an acute reaction that may include dyspnea, hypoxemia, respiratory failure, hypotension, and fever.
Posttransfusion purpura
Posttransfusion purpura (PTP) is an immune thrombocytopenia. This is more common in women who have been pregnant.
Graft-versus-host disease
Transfusion associated graft-versus-host disease (TA-GVHD) is when the donor's blood attacks the recipient's body.
Nonimmunologic
Nonimmune hemolysis
Nonimmune hemolysis may be due to physical destruction of donor blood from heating or freezing.
Chemical reactions
- Hemosiderosis
- Hypocalcemia from citrate toxicity
- Hyperkalemia
- Metabolic alkalosis and hypokalemia due to citrate
Transmission of infection
Transfusion associated sepsis may manifest 'fever > 40°C and/or cardiovascular collapse.'[1]
Other reactions
- Air embolus may manifest 'sudden dyspnea, cyanosis, chest pain, cough, hypotension, cardiac arrhythmia.'[1] ICD9: 999.1
- Hypothermia
- Circulatory overload may cause dyspnea.
- Hypotension associated with leukoreduced blood and maybe angiotensin-converting enzyme may cause flushing and hypotension.
References
- ↑ 1.0 1.1 1.2 Sanders RP, Geiger TL, Heddle N, Pui CH, Howard SC (April 2007). "A revised classification scheme for acute transfusion reactions". Transfusion 47 (4): 621–8. DOI:10.1111/j.1537-2995.2007.01163.x. PMID 17381620. Research Blogging.
- ↑ Anonymous (2024), Blood group incompatibility (English). Medical Subject Headings. U.S. National Library of Medicine.