Makindo Medical Notes

📑 Crib Sheet: Transfusion Reactions

All patients receiving a blood component transfusion are at risk of an adverse transfusion reaction. ⚠️ Severe reactions (e.g. TRALI, TACO, acute haemolysis) must be reported to the hospital blood bank.

📊 UK SHOT Data (2017)

• 2 million transfusions → 372 acute reactions (≈1 in 5,376)
• 42 haemolytic reactions (≈1 in 48,000)
• 3 TRALI (≈1 in 666,000)
• 92 TACO (≈1 in 22,000)

🚨 If Reaction Suspected

• 🛑 Stop the transfusion immediately.
• Assess with NEWS + ABCDE.
• Check correct patient and correct blood.
• Maintain IV line with normal saline if needed.
• Record observations every 15 min.
• Haemolysis or bacterial infection = most serious complications.

🌡️ Febrile Non-Haemolytic Reaction

• Occurs in ≈1% of transfusions (RBCs, platelets, FFP).
• Cause: Plasma pyrogens or leucocyte antibodies.
• Clinical: 30 min after start → fever (↑1–2°C to 38–39°C), chills, malaise, urticaria, pruritus.
• Management: Stop/slow transfusion, give paracetamol 1 g PO/IV, ± chlorphenamine. Restart if symptoms settle.
• Close monitoring q15min.

💥 Acute Haemolytic Reaction (ABO Incompatibility)

• Usually due to clerical/crossmatch error → 10% mortality.
• Clinical: Within minutes → fever, chills, hypotension, tachycardia, dyspnoea, chest/back pain, vomiting, haemoglobinuria.
• Tests: FBC, U&E, LFT, coagulation, DAT, lactate, blood cultures, urine Hb.
• Management:
  • Stop transfusion, check IDs, change tubing.
  • IV saline → diuresis (insert catheter, monitor urine output).
  • IV furosemide if volume status allows.
  • High-flow oxygen, monitor for AKI/DIC.
  • Discuss with haematology/ICU, return blood units to lab.
  • Consider antibiotics if sepsis in differential.

🤧 Anaphylaxis

• Symptoms: Wheeze, swelling, pain, hypotension, collapse.
• May occur in IgA deficiency exposed to donor IgA.
• Treatment: Stop transfusion, oxygen, IM adrenaline 0.5 mg, IV fluids. Consider IV hydrocortisone + chlorphenamine.

🦠 Bacterial Contamination

• Fever, hypotension, septic shock, DIC.
• Usually immediate, often lethal.
• Treatment: Stop transfusion, send blood cultures, follow sepsis 6, start IV antibiotics.

🧬 Viral Transmission

• Screened for: HBV, HCV, HIV, HTLV.
• CMV-negative blood: required for bone marrow & organ transplant patients.
• Other rare risks: syphilis, malaria, toxoplasmosis.

💧 TACO (Transfusion-Associated Circulatory Overload)

• Acute dyspnoea, tachycardia, raised JVP, pulmonary oedema on CXR.
• Prevention: Give slowly (over 3–4 hrs) + diuretics.
• Treatment: Oxygen, IV diuretics, manage as cardiogenic pulmonary oedema.

🌫️ TRALI (Transfusion-Related Acute Lung Injury)

• Due to donor anti-leucocyte antibodies.
• Acute breathlessness, pulmonary oedema, cough.
• CXR: Bilateral infiltrates (non-cardiogenic oedema).
• Treatment: Supportive → oxygen, treat like ARDS. Prognosis usually good.

🧾 Other Rare Reactions

• Transfusion-Related GvHD: Immunocompromised host → fever, rash, liver dysfunction 1 wk later. Prevent with irradiated blood.
• Post-Transfusion Purpura: 10–14 days later → severe thrombocytopenia due to anti-HPA-1a. Treat with IVIg ± plasma exchange.

📚 References

• Trust Guideline: Blood Transfusion Reactions

Clinical Pearl: Always suspect ABO mismatch if severe symptoms occur within minutes of starting a transfusion. If breathless, distinguish TACO (fluid overload) vs TRALI (immune-mediated lung injury) — both need stopping transfusion immediately, but management differs.