Blood transfusion reactions

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. 


Qs: 4672


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