Pocket Medicine

HEMATOLOGY-ONCOLOGY

TRANSFUSION THERAPY

Transfusion reactions

•  For all reactions (except minor allergic): stop transfusion; send remaining blood product and fresh blood sample to blood bank

•  Acute hemolytic: fever, hypotension, flank pain, renal failure <24 h after transfusion

Due to ABO incompatibility → preformed Abs against donor RBCs

Treatment: vigorous IVF, maintain UOP with diuretics, mannitol or dopamine

•  Delayed hemolytic: generally less severe than acute hemolytic; 5–7 d after transfusion

Due to undetected allo-Abs against minor antigens → anamnestic response

Treatment: usually no specific therapy required; dx is important for future transfusion

•  Febrile nonhemolytic: fever and rigors 0–6 h after transfusion

Due to Abs against donor WBCs and cytokines released from cells in blood product

Treatment: acetaminophen ± meperidine; r/o infection and hemolysis

•  Allergic: urticaria; rarely, anaphylaxis: bronchospasm, laryngeal edema, hypotension Reaction to transfused proteins; anaphylaxis seen in IgA-deficient Pts w/ anti-IgA Abs

Treatment: urticaria → diphenhydramine; anaphylaxis → epinephrine ± glucocorticoids

•  Transfusion-related acute lung injury (TRALI): noncardiogenic pulmonary edema Due to donor Abs that bind recipient WBCs, which then aggregate in pulmonary vasculature and release mediators causing ↑ capillary permeability Treatment: see “ARDS”