1. A 68-year-old woman with a background of chronic myeloid leukemia presented to the emergency department with respiratory distress and fever after receiving a blood transfusion. 2. She was found to have a fever, low oxygen saturation, rapid breathing, and rapid heart rate, suggesting a potential transfusion reaction. 3. Initial management involved stopping the transfusion, monitoring vital signs, and performing investigations to identify the type of reaction and guide further treatment. Prevention of transfusion reactions is important through proper patient identification, following protocols, and identifying high-risk groups.

1. TRANSFUSION
REACTIONS AND
COMPLICATIONS
09/10/2014 CME Teaching
Emma McVeigh

2. CASE REPORT
68 year old lady background of CML referred to Emergency Department
from the Transfusion Day Ward. She was receiving 2nd unit RBC when
became febrile and increasingly dyspnoeic.
O/E:
Pyrexic 38.7oc
Oxygen Sat 90% R.A. RR28
HR104
BP101/68

3. INVESTIGATIONS
CXR:

4. MANAGEMENT
???

5. BLOOD TRANSFUSION
IN ED

6. BLOOD TRANSFUSION
REACTIONS
Febrile non-haemolytic transfusion reaction
Bacterial Infection reaction
Allergic/ Urticarial transfusion reaction
Anaphylactic/ Immunologic transfusion reaction
Transfusion Associated Acute Lung Injury (TRALI)
Transfusion Associated Circulatory Overload (TACO)
Iron Overload
Acute Haemolytic Reaction
Delayed Haemolytic Reaction
Transfusion Associated Graft – VS – Host Disease

7. FEBRILE NON-HAEMOLYTIC
REACTION

8. BACTERIAL TRANSFUSION
REACTION

9. ALLERGIC / URTICARIAL
REACTION

10. ANAPHYLACTIC REACTION

11. T.R.A.L.I.

12. CANADIAN CONSENSUS
CRITERIA FOR
TRANSFUSION-RELATED
ATRACLI: UTE LUNG INJURY
1. Acute onset during or within 6 hours of transfusion
2. Hypoxemia
3. Bilateral infiltrates on chest x-ray
4. No evidence of volume overload
5. No preexisting lung injury
6. No alternative risk factor for ALI
Possible TRALI:
1. Criteria for TRALI, as stated above in criteria 1-5
2. Alternative risk factor for ALI identified (ie, sepsis)
Abbreviations: ALI, acute lung injury; TRALI, transfusion-related acute lung injury.

13. T.A.C.O.

14. IRON OVERLOAD

15. ACUTE HAEMOLYTIC
REACTION
Clinical Features Pathophysiology
Emergency!! ABO incompatible blood, eg group A, B or AB red
cells to a group O patient
Haemolysis Human error
Fever
Back pain
Haemoglobinuria
ARF
DIC
Note: Difficult to assess patients – intubated/ ICU
setting

16. DELAYED HAEMOLYTIC
REACTION

17. TRANSFUSION ASSOCIATED
GRAFT-VS-HOST DISEASE
(GVHD)

18. MANAGEMENT OF
TRANSFUSION REACTION
1. Stop the transfusion immediately
2. Check and monitor vital signs
3. Maintain intravenous (IV) access (Do not flush existing line and use a new IV line if
required)
4. Check the right pack has been given to the right patient
5. Notify Lab

19. 2014 Australian Red Cross Blood Service

20. SCGH GUIDELINES
http://chips/departments/transfusionservices/pdf/PolicyManu
al/Transfusion%20Reaction%20Algorithm.pdf
http://chips/departments/transfusionservices/pdf/PolicyManu
al/Transfusion%20Reaction%20Algorithm.pdf

21. INVESTIGATIONS
 Immediate post transfusion blood samples (clotted and EDTA)
 Repeat ABO & Rh (D) grouping
 G+XM
 Direct antiglobulin test
 FBC
 Haptoglobin
 Coagulation screen
 RFT
 LFTSs (BR)
 DIC (DD/Fibrinogen)
 Blood culture in special blood culture bottles
 Blood unit
 Specimen of patient’s first urine following reaction
 u/a - bilirubin

22. RISK FACTORS
1. Individual patient characteritics
2. Blood Component
3. Equi[ment
4. Concomitant Medications
5. Procedures

23. PREVENTION

24. PREVENTION
1. Correct identification patient and blood products
2. Following protocol
3. ?use of prophylactic drugs
4. Identification of risk groups
5. Treatment of blood products

25. PATIENTS FOR WHOM GAMMA
IRRADIATED BLOOD
PRODUCTS SHOULD BE
CONSIDERED
1. Patients with known or suspected congenital immunodeficiency
syndromes
2. Patients with hematologic malignancies (leukemia, lymphoma)
3. Patients with solid tumors receiving chemotherapy
4. Patients after bone marrow transplant
5. Patients receiving human leukocyte antigen-matched donations or
directed blood prodcuts from first-degree relatives

26. PATIENTS FOR WHOM
LEUKOREDUCED BLOOD
PRODUCTS SHOULD BE
CONSIDERED
1. Patients who are non-hepatic solid organ transplant candidates
2. Patients who have had 1 or more documented FNHTR
3. Patients requiring long-term platelet support (eg, aplastic anemia, ITP)
4. Patients at risk for clinically significant CMV infection (eg, bone marrow
transplant recipients, etc.)
5. Abbreviations: CMV, cytomegalovirus; FNHTR, febrile nonhemolytic
reaction; ITP, idiopathic thrombocytopenic purpura

27. CASE REPORT
68yo lady b/g CML px ED with Respiratory Distress and
febrile
?Diagnosis
?Management Plan

28. SUMMARY…
1. Risk Factors for Transfusion Reaction
2. Early Identification
3. Early Notification
4. Supportive Management
5. Prevention Transfusion Reaction

29. REFERENCES
1. Toy P, Popovsky MA, Abraham E, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33(4):721-
726. (Review)
2. Kleinman S, Caulfield T, Chan P, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus
panel. Transfusion. 2004;44(12):1774-1789.
3. 2014 Australian Red Cross Blood Service. http://www.transfusion.com.au/adverse_events/management_steps
4. Rosa Sanchez, MD, Peter Bacchetti, PhD, Pearl Toy, MDTransfusion-Related Acute Lung Injury: A Case-Control Pilot Study of Risk
Factors American Journal of Clinical Pathology. Am J Clin Pathol. 2007;128(4):128-134. v
5. Reprinted from Transfusion Medicine Reviews, Vol 6/ issue 2, Jeanne V. Linden, Patricia T. Pisciotta. Transfusion-associated graft-versushost
disease and blood irradiation, pages 116-123. Copyright 1992. Elevesier.
6. Ratko TA, Cummings JP, Oberman HA, et al.Evidencebased recommendations for the use of WBC-reduced cellular blood
components. Transfusion. 2001;41(10):1310-1319
7. Cadogan m. http://www.lifeinthefastlane.com/education/symptoms/transfusion-reaction/ Dec 2011

30. THANK YOU!
??????QUESTIONS???
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