Pocket Oncology (Pocket Notebook Series), 1st Ed.

TRANSFUSION MEDICINE

Neha Mehta and David Wuest

ABO Matching

• Type & Screen: Checks ABO & Rh typing & for clinically significant allo-Abs

• Type & Cross: Final check for compatibility between pt & blood product being issued

• Mgmt of plt alloimmunization: Allo-Abs form against plt Ags (HLA & plt-specific Ags), results in refractory thrombocytopenia despite transfusions

• Dx: Failure to ↑ plt count 15 min–1 h post-transfusion × 2

• Treatment: Transfusion w/HLA-matched or crossmatched plt

Types of Transfusion Reactions:

• Acute hemolytic: Due to clinically significant RBC Ag incompatibility; may p/w fever, HoTN, AKI, flank pain, or hemoglobinuria

• Delayed hemolytic: Due to undetected alloantibodies, occurs 5–7 d after transfusion; no need for specific Rx

• Febrile rxn: Due to Abs against donor WBCs or cytokines generated during storage; p/w fever & rigors 0–6 h after transfusion; treat w/acetaminophen; must r/o hemolysis & infxn

• Allergic: Due to rxn to plasma proteins in blood product

• Mild: Urticaria & pruritus; treat w/antihistamine

• Mod. to sev.: Urticarial, dyspnea, HoTN, anaphylaxis; classically seen in pts w/IgA deficiency; must treat w/epinephrine & steroids

• TRALI: Primarily due to donor Abs binding to WBCs & cause capillary permeability in lungs; presents like ARDS post-transfusion; treat like ARDS

• For all transfusion rxn: Stop transfusion, maintain IV access, verify correct unit was given to pt, notify blood bank

• For mod.-to-sev. rxn: Obtain UA, post-transfusion specimen & ask blood bank to evaluate the unit delivered