Anaphylactic: Rapid onset(seconds to minutes) of shock, respiratory distress(difficulty breathing with wheezing or bronchospasm), angioedema, urticaria and hypotension. Occurs in those that are IgA deficient, due to the production of anti-IgA IgG Abs.
Treatment: Stop transfusion, antihistamines, steroids and IM epi. +/- hemodynamic support with vasopressor and MV.
Prevention: Future transfusion with IgA-deficient plasma and washed red cell products.
Primary Hypotension Reaction: Within minutes in patients using ACEIs due to bradykinin in blood products that is normally degraded by ACE. Hypotension is transient.
ABO Mismatch: Onset often within an hour with fever, chills, flank pain and hemoglobinuria. May progress to ARF and DIC
Bacterial sepsis: Fever, chills, septic shock and DIC within minutes to hours.
Urticarial/Allergic: Urticaria, flushing, angioedema and pruritis arising within 2-3 hours caused by recipeint IgE Abs and mast cell activation.
Febrile Nonhemolytic(most common rxn): Presents with fever and chills within 6 hours of transfusion. Due to cytokine accumulation during blood storage.
Transfusion related acute lung injury: Within 6 hours of transfusion related to donor’s anti-leukocyte Abs. Causes respiratory distress and signs of noncardiogenic pulmonary edema.
Delayed hemolytic: Mild fever and hemolytic anemia(+direct Coombs and ab screen) presenting within 2-10 days. Caused by anamnestic Ab response.