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