Transfusion reactions

Transfusion reactions

Transfusion reactions are adverse events that can occur when blood or blood products are transfused into a patient. These reactions can be classified into several categories based on their timing and the immune response involved. Here are the main types of transfusion reactions:

1. Acute Hemolytic Reaction:
   • Cause: Incompatibility between the donor’s and recipient’s blood, typically due to ABO or Rh blood group mismatch.
   • Symptoms: Fever, chills, nausea, chest pain, back pain, hemoglobinuria (presence of hemoglobin in the urine), and potentially life-threatening complications such as renal failure and shock.
   • Management: Stop the transfusion immediately, provide supportive care, and initiate investigations to determine the cause.
2. Febrile Non-Hemolytic Reaction:
   • Cause: Typically caused by leukocyte antibodies in the recipient reacting with donor leukocytes, or by cytokines in the blood product.
   • Symptoms: Fever, chills, and rigors without evidence of hemolysis.
   • Management: Stop the transfusion, administer antipyretics, and consider leukoreduction in future transfusions.
3. Allergic Reaction:
   • Cause: Sensitization to allergens in the donor’s plasma, such as proteins or preservatives.
   • Symptoms: Hives, itching, and, in severe cases, anaphylaxis.
   • Management: Antihistamines and, in severe cases, epinephrine.
4. Transfusion-Related Acute Lung Injury (TRALI):
   • Cause: Antibodies in the transfused blood react with the patient’s leukocytes, leading to acute respiratory distress.
   • Symptoms: Sudden onset of respiratory distress, hypoxia, and non-cardiogenic pulmonary edema.
   • Management: Supportive care with oxygen therapy and, in severe cases, mechanical ventilation.
5. Transfusion-Associated Circulatory Overload (TACO):
   • Cause: Rapid infusion of a large volume of blood, leading to circulatory overload.
   • Symptoms: Dyspnea, orthopnea, hypertension, and, in severe cases, pulmonary edema.
   • Management: Slow down or stop the transfusion, administer diuretics, and provide respiratory support if necessary.
6. Delayed Hemolytic Reaction:
   • Cause: Delayed immune response to an antigen on the transfused red blood cells.
   • Symptoms: Gradual drop in hemoglobin levels, jaundice, and mild fever.
   • Management: Supportive care and monitoring, with consideration of future transfusions with antigen-matched blood. 

What is the transfusion process?

The transfusion process involves the administration of blood or blood products to a recipient to replace lost components or to treat specific medical conditions. Here is an overview of the typical steps in the transfusion process:

1. Prescription and Indication:
   • A healthcare provider assesses the patient’s medical condition and determines the need for a blood transfusion based on clinical indications, such as surgery, trauma, anemia, or other medical conditions.
2. Informed Consent:
   • The healthcare provider explains the risks and benefits of the transfusion to the patient or their legal representative. Informed consent is obtained before proceeding with the transfusion.
3. Blood Typing and Crossmatching:
   • Blood samples from the recipient are collected to determine the patient’s blood type (ABO and Rh) and to crossmatch with the donor blood to ensure compatibility. This step is critical to prevent transfusion reactions.
4. Donor Blood Selection:
   • Based on the recipient’s blood type and specific medical requirements, compatible blood or blood products are selected from the blood bank.
5. Preparation of Blood Products:
   • The selected blood is processed and prepared into specific blood products, such as packed red blood cells, platelets, plasma, or cryoprecipitate, depending on the patient’s needs.
6. Administration Setup:
   • A dedicated intravenous (IV) line is established for the transfusion. A blood administration set with a filter is used to deliver the blood product to the patient.
7. Patient Identification:
   • The healthcare team verifies the patient’s identity using at least two unique patient identifiers (e.g., name, and date of birth) before starting the transfusion. This step is crucial to prevent administration errors.
8. Pre-Transfusion Vital Signs:
   • Baseline vital signs, including temperature, heart rate, respiratory rate, and blood pressure, are recorded before starting the transfusion. This provides a reference for monitoring any changes during the procedure.
9. Initiation of Transfusion:
   • The blood product is administered slowly initially, and the patient is closely monitored for any signs of adverse reactions. Transfusions are typically started within 30 minutes of receiving the blood from the blood bank.
10. Continuous Monitoring:
    • Throughout the transfusion, the healthcare team monitors the patient for signs of adverse reactions, including vital signs, skin color, and overall well-being.
11. Post-Transfusion Documentation:
    • After completing the transfusion, the healthcare team documents the details of the procedure, including the amount and type of blood product administered, any adverse reactions, and the patient’s response.
12. Post-Transfusion Vital Signs:
    • Vital signs are recorded again after completing the transfusion to assess the patient’s overall response. 

The transfusion process is designed to ensure the safety and well-being of the recipient by preventing complications and transfusion reactions. Strict adherence to established protocols, thorough patient identification, and continuous monitoring are essential components of a safe transfusion process.

FAQs:

1. What is a transfusion reaction?
   • Answer: A transfusion reaction is an adverse response that occurs during or after a blood transfusion. It can result from various factors, including incompatible blood types, antibodies, or other immune responses.
2. What are the common types of transfusion reactions?
   • Answer: Transfusion reactions can be classified into several types, including acute hemolytic reactions, febrile non-hemolytic reactions, allergic reactions, transfusion-related acute lung injury (TRALI), and others.
3. What causes acute hemolytic reactions?
   • Answer: Acute hemolytic reactions are often caused by the transfusion of incompatible blood, leading to the rapid destruction of red blood cells. This can occur due to ABO or Rh incompatibility.
4. What are the symptoms of a febrile non-hemolytic reaction?
   • Answer: Febrile non-hemolytic reactions are characterized by fever, chills, and rigors. These reactions are commonly caused by the recipient’s immune response to donor white blood cells or platelets.
5. How are allergic reactions during transfusion treated?
   • Answer: Allergic reactions during transfusion, such as hives or itching, are typically mild. Antihistamines can be administered to alleviate symptoms. In severe cases, stopping the transfusion may be necessary.
6. What is TRALI?
   • Answer: Transfusion-Related Acute Lung Injury (TRALI) is a severe reaction that can cause acute respiratory distress shortly after a blood transfusion. It is characterized by the sudden onset of difficulty breathing and lung injury.
7. How are transfusion reactions managed?
   • Answer: The management of transfusion reactions depends on the type and severity of the reaction. Treatment may involve stopping the transfusion, administering medications (such as antihistamines or corticosteroids), and providing supportive care.
8. How can transfusion reactions be prevented?
   • Answer: To prevent transfusion reactions, careful blood typing and crossmatching are essential. Healthcare providers must follow proper transfusion protocols, and patients should be monitored closely during and after transfusions.
9. What is the role of premedication in preventing transfusion reactions?
   • Answer: Premedication with antipyretic medications or antihistamines may be considered in certain cases to reduce the risk of febrile non-hemolytic reactions or allergic responses.
10. Can delayed transfusion reactions occur?
    • Answer: Yes, delayed transfusion reactions can occur days to weeks after a transfusion. These reactions may involve delayed hemolytic reactions or immune-mediated complications.