Blood Transfusion Pearls Key points for your Board Review
Two types of transfusion reactions: minor and critical
Minor transfusion reactions include: febrile non-hemolytic transfusion reaction and simple allergic/urticarial reaction
Critical transfusion reactions include: acute hemolytic transfusion reaction, sepsis, severe allergic/anaphylactic reaction, transfusion related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO)
Suspect acute transfusion reaction? Stop the transfusion, verify the blood product, and call the blood bank; if symptoms are severe, send labs (especially Coombs); symptom-based diagnosis is critical!
Febrile non-hemolytic transfusion reaction: asymptomatic low-grade fever; treat with antipyretics
Simple allergic transfusion reaction: isolated urticaria; treat with antihistamines
Acute hemolytic transfusion reaction: high fever + shock; due to ABO incompatibility; treat supportively, IV fluids
Sepsis: high fever + shock; treat supportively, IV fluids and antibiotics
Severe allergic/anaphylactic transfusion reaction: treat with epinephrine
Transfusion-Related Acute Lung Injury: respiratory distress + hypotension; noncardiogenic pulmonary edema; treat supportively, no furosemide
Transfusion-Associated Circulatory Overload: respiratory distress + hypertension; treat supportively, with furosemide
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