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Transfusion reactions
Doctor Omid Reza Zekavat
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Transfusion reactions
Type
Etiology
Presentation
Evaluation
Treatment
Hemolytic
(immune)
ABO incompatibility
Fever, hemoglobinuria,
nausea/vomiting, pain, DIC
DCT, PBS,U/A, LFT, BUN/
Cr, PT/PTT
Supportive care
Hemolytic
(non-immune)
Physical or chemical
destruction
Hemoglobinuria
PBS, negative DCT
Supportive care
Fever/Chill
Anti body to donor WBC
or plasma protein
Nausea/ vomiting,
chills/rigors
R/O hemolysis
Antipyretic,
Prevention: LD- product,
premedication
Allergic
Antibody to plasma
proteins
Urticaria ,pruritis to RDS ,
hypotension
Response to
antihistamines
Antihistamines to
epinephrine
Most frequent in Plt
Fever/chills, shock
Blood culture
Supportive
(mild to severe)
Bacterial contamination
Doctor Omid Reza Zekavat
Delayed transfusion reactions
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Occur 5-14 days after transfusion
Characterized by unexpected levels of anemia, as well as malaise and jaundice
Due to an alloantibody that was not detectable at the time of transfusion
Investigate the presence of a new antibody
Doctor Omid Reza Zekavat
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Transfusion-related acute lung injury (TRALI)
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Severe complication
Specific anti-neutrophil or anti-HLA antibodies
Characterized by dyspnea, tachycardia, fever and hypotension during or
within six hours of transfusion.
chest radiograph shows bilateral infiltrates
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typical of pulmonary edema
Management includes oxygen, administration of steroids and diuretics
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when needed, assisted ventilation.
Doctor Omid Reza Zekavat
4
Transfusion-induced graft versus host disease
(TI-GVHD)
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Caused by viable lymphocytes in units of transfused red cell.
rare but often fatal
Immunosuppressed patients are at particular risk
Immunocompetent recipients of red cells from a haploidentical donor such as a
family member.
Occurs within 1-4 weeks of transfusion
Characterized by fever, rash, liver dysfunction, diarrhea and pancytopenia due to
bone marrow failure.
Donated blood from a family member should be avoided or if used should always be
irradiated before transfusion.
Leucodepletion alone is inadequate for the prevention of this complication.
Doctor Omid Reza Zekavat
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Patients need irradiated products
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Cellular immunodeficiency
Intrauterine transfusion / Exchange transfusion
Blood component from related donor
Hematopoietic cell transplant recipients
Receiving HLA-matched cellular blood component
Hematologic or lymphatic malignancies
Cancer on chemotherapy
Irradiated RBC make lymphocyte inactivated and result in fade of GVHD
complication.
Doctor Omid Reza Zekavat
6
Transfusion-associated circulatory overload
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Occur in the presence :
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recognized or unrecognized cardiac dysfunction
when the rate of transfusion is inappropriately fast
Signs and symptoms include dyspnea and tachycardia.
Treatment focuses on volume reduction and cardiac support
Doctor Omid Reza Zekavat
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Transfusion transmitted disease

HIV 1/ 2
 Screening test: NAT(
nucleic acid amplification)
 Window period: 11 days
 HTLV-I-II
 Screening test: Anti-HTLV
 Window period: 51 days

HCV
 Screening test: NAT(
nucleic acid amplification)
 Window period: 10 days

HBV
 HBS Ag
 Window period: 59 days
Doctor Omid Reza Zekavat
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Transfusion transmitted disease
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Newly emerging infectious agents (WNV, SARS, Avian Flu, prions)
parasitic protozoa: Chaga’s disease, toxoplasmosis and babesiosis
Doctor Omid Reza Zekavat
9
CMV infection
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Patient at risk for:
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Congenital immune deficiency
AIDS
Hematopoietic cell transplant recipients
Organ transplant
Premature infant
Cancer patients on chemotherapy
Intrauterine transfusion
Doctor Omid Reza Zekavat
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‫‪Case-1‬‬
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‫پسری ‪ 12‬ساله ده دقیقه پس از دریافت خون دچار تب ‪ 38.5‬میشود‪ ،‬در کودک مورد نظر ‪:‬‬
‫اولین پیشنهاد درمانی شما؟‬
‫قطع تزریق خون‬
‫برای تایید تشخیص خود آزمایشهای مورد استفاده کدام است؟‬
‫آزمایش خون محیطی‪ ،‬آزمایش ادرار‪ ،‬آزمایش ‪PT&PTT ، LFT ، BUN&CR ، DCT‬‬
‫در صورتی که تشخیص همولیز رفع شد ‪ ،‬برای بیمار فوق پیشنهاد چیست؟‬
‫ضد تب ‪ ،‬شروع مجدد تزریق با سرعت کمتر ‪ ،‬دادن ضد تب در دفعات بعدی تزریق‬
‫‪Doctor Omid Reza Zekavat‬‬
‫‪Case-2‬‬
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‫بیمار تاالسمی ‪ 8‬ساله شما به تازگی بد دنبال دریافت خون دچار راش پوستی و تنگی نفس مالیم میگردد‪:‬‬
‫در این بیماران شایعترین علت؟‬
‫حساسیت به پروتین های موجود در پالسما‪.‬‬
‫توصیه ابتدایی به این بیمار؟‬
‫استفاده از آنتی هیستامین قبل از تزریق خون‪.‬‬
‫اگر در این بیمار فوق با توصیه شما در بار بعدی دچار تنگی نفس شدید شد پیشنهاد شما ؟‬
‫استفاده از خون شسته شده‪.‬‬
‫‪Doctor Omid Reza Zekavat‬‬
‫‪Case-3‬‬
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‫بیمار تاالسمی مورد درمان مرکز شما به علت سرطان خون تحت شیمی درمانی قرار گرفته است در بیمار فوق باید به‬
‫چه احتمال عفونی در زمان تزریق خون بعدی توجه کرد؟‬
‫عفونت با ‪CMV‬‬
‫برای جلوگیری توصیه شما چیست؟‬
‫استفاده از خون ‪Pre-storage WBC reduced‬‬
‫‪Doctor Omid Reza Zekavat‬‬