Transfusion Associated Events

Type Event Symptoms Dx Treatment Prevention
Acute -Febrile Hemolytic, immune (AHTR) Fever/chills Back pain Hemoglobinemia Hemoglobinuria Hypotension, renal failure Shock DIC DAT positive ↓ Hemoglobin ↑ LDH ↑ Bilirubin ↓ Haptoglobin Discontinue transfusion Maintain vascular access Maintain blood pressure Maintain renal blood flow Treat DIC if present Follow standard operating procedures for identification of the patient
Acute –Febrile Hemolytic nonimmune (ANIHTR) Asymptomatic Hemoglobinuria DAT negative Discontinue transfusion Maintain vascular access Maintain renal blood flow Follow standard operating procedures for equipment operation
Acute –Febrile Transfusion associated Sepsis (TAS) Fever/chills Hypotension Shock DAT negative
Gram stain blood bag Culture blood bag Culture patient  Discontinue transfusion Maintain vascular access Consider initial broad-spectrum antibiotic coverage Follow standard operating procedures for collection Implement bacterial detection intervention prior to transfusion
Acute –Febrile Febrile nonhemolytic (FNHTR) Fever/chills Nausea/vomiting Tachycardia Tachypnea ↑ Blood pressure DAT negative Treat with antipyretics For rigors, treat with meperidine Prestorage leukoreduction of PRBC and platelets
Acute – Allergic Allergic, mild Erythema Pruritus Clinical diagnosis DAT not required Temporary discontinue transfusion Treat with antihistamines If symptoms improve restart transfusion For repeated reactions, consider premedication with antihistamines
Acute – Allergic Severe anaphylaxis Angioedema Wheezing Hypotension Anaphylaxis DAT negative
IgA deficiency workup when indicated  Discontinue transfusion Maintain vascular access Treat with subcutaneous epinephrine Maintain blood pressure Provide respiratory support For IgA absolute deficient patients provide IgA deficient blood components
Acute – Pulmonary Transfusion Associated Circulatory Overload (TACO) Severe hypoxemia ↑ Blood pressure Jugular vein distension ↑ Central venous pressure CXR: pulmonary edema, cardiomegaly, distended pulmonary artery BNP Upright posture Supplemental oxygen Diuresis Slower transfusion rate Transfuse in smaller volumes
Acute – Pulmonary Transfusion Related Acute Lung injury (TRALI) Severe hypoxemia No evidence of left atrial hypertension CXR: bilateral infiltrates Donor test for HLA/HNA antibodies Recipient test for HLA/HNA antigens Discontinue transfusion Maintain vascular access Supplemental oxygen Mechanical ventilation Use male only plasma Exclude or screen female platelet donors
Acute – other Massive transfusion related
Delayed Delayed hemolytic reaction (DSHTR) Asymptomatic Fatigue + Antibody screen/DAT ↓ Hemoglobin As needed Transfuse antigen negative, AHG crossmatched compatible PRBC Accurate record-keeping Obtain transfusion history Limit transfusions
Delayed Delayed Hemolytic Transfusion Reaction (DHTR) Flulike symptoms Pallor Jaundice ↓ Hemoglobin ↑ Total bilirubin As needed Transfuse antigen negative, AHG crossmatched compatible PRBC Accurate record-keeping Obtain transfusion history Limit transfusions
Delayed Transfusion Associated Graft Vs. Host Disease (TAGVHD) Rash Fever Diarrhea Pancytopenia Identify donor engraftment Not available Gamma irradiation of cellular blood components as indicated
Delayed Post transfusion purpura Bleeding Thrombocytopenia HPA antibodies Intravenous immunoglobulin Limit transfusions
Delayed Iron overload Multi-organ failure High ferritin levels Use of iron-chelating agents Prophylactic use of iron-chelating agents Red cell exchange
Silent RBC allo-immunization
Silent Platelet alloimmunization
Special Plasma derivatives
Special Therapeutic apheresis
Special Neonatal
Special Pediatric
Special Autologous