Immediate Transfusion Reaction Type of reaction Transfusion associated sepsis Definition Bacterial contamination of transfused blood Symptoms Shaking

g chills Hemoglobinuria DIC Oliguria/anuria Fever over 39C (or 102F), or rise of 2C or 3.5F over pretransfusion values Heart rate 120/min, or rise of 40/min from pretransfusion values Drop or rise in blood pressure of 30/mm Hg over pretransfusion values Temperature increase of >1C Temperature increase 1C associated with transfusion or 2F and without any other Chills explanation Rigors Transfused RBCs interact with Fever, (rise of 1C or 2F) pre-formed antibodies in Chills recipient Pain in chest, lower back, abdomen, and/or at infusion site Hypotension (decrease by 20 mmHg) Nausea Flushing Dyspnea Hemoglobinemia Hemoglobinuria Bilirubinemia/Billirubinuria Oliguria/Anuria Acute pancreatitis Shock Generalized bleeding (DIC) Mid allergic reaction to Generalized rash, transfusion erythematous macular eruption Hives Itching Usually without fever Severe allergic reaction to Coughing, bronchospasm, transfusion in which there are respiratory distress systemic symptoms Vascular instability,

Febrile non-hemolytic reactions

Immune-mediated hemolysis

Urticaria (Hives)

Anaphylactic reactions (occur after infusion of only a few mL of blood component)

Air Embolism

Transfusion-related acute lung injury (TRALI)

Transfusion Associated Circulatory Overload (TACO)

Metabolic reactions

Hypothermia

hypotension Nausea, abdominal cramps, vomiting Diarrhea Shock Air allowed into infusion Cough equipment or blood in open Dyspnea system infused under pressure Chest pain causing air bubble Shock A new episode of acute lung Acute respiratory injury (ALI) that occurs insufficiency in the absence of during or within 6 hours of a evidence of circulatory completed transfusion overload No left atrial hypertension Acute onset Hypoxemia (capillary oxygen decreases to <90% on room air) Bilateral infiltrates on frontal chest x-ray No other evidence of cardiac failure or a cause for respiratory failure Acute pulmonary edema due Dyspnea, orthopnea to volume overload Severe headache Hypertension, tachycardia Congestive heart failure Acute pulmonary edema Metabolic derangements Citrate toxicity resulting from large-volume Hyperkalemia transfusions Hypocalcimia Hypothermia Respiratory alkalosis Depressed body temperature Hypothermia resulting from rapid infusion Cardiac arrhythmia or arrest of large volumes of cold blood Exacerbation of underlying components coagulopathy

Delayed Transfusion Reactions Alloimmunization to red cell antigens (usually an anamnestic immune response that occurs from 3-10 days post-transfusion) Development of newly formed antibodies to red cell antigens Fever Decreasing hemoglobin Mild jaundice Signs of hemolysis in about 20-35% of sensitized recipients Signs of febrile nonhemolytic transfusion reactions

Alloimmunization to leukocyte antigens Occurs in patients receiving repeated platelet transfusions and women with for > 4 pregnancies Refractoriness to platelet transfusion

Development of antibodies to leukocyte (HLA) antigens

Post-transfusion purpura (usually occurs > 1 week after transfusion) Iron overload Occurs in chronically transfused patients (> 20 units per lifetime) Acute Transfusion-associated Graft-vs-Host disease

Rapid clearance of transfused platelets due to HLA sensitization or other clinical factors Abrupt onset of severe thrombocytopenia an average of 9 days post transfusion (range 1-24 days) Accumulation of iron and no physiologic means of excretion

Poor incremental increase in platelet count after a suitable dose of platelets Precipitous fall in platelet count Generalized purpura Interference with heart, liver or endocrine gland function Hepatic failure Cardiac toxicity Fever Erythroderma, often starting on palms, soles, earlobes, and face, ranging from edema to full blistering Enterocolitis

Immunologic complication caused by engraftment and proliferation of donor lymphocytes in a susceptible host