Blood Transfusion Reaction

Febrile, nonhemolytic reaction

• typically are managed with acetaminophen.
• caused most commonly by host antibodies directed against human leukocyte antigens (HLA) on white blood cells that may be present in the blood product.
• Antibodies may develop after sensitization from a prior transfusion or, in adult women, after pregnancy.
• Reaction of host HLA antibodies against donor leukocyte alloantigens typically causes fever, chills, and in severe cases, pulmonary infiltrates.
• This type of transfusion reaction is minimized by depleting the blood product of leukocytes via a filtering process. Leukoreduction is also effective in reducing the risk of leukocyte-associated virus transmission, such as cytomegalovirus, Epstein-Barr virus, and human T-cell lymphotropic viruses (HTLVs).

Febrile, allergic reaction

• urticaria, dyspnea, bronchospasm, or oral/facial edema.
• This type of reaction usually is caused by hypersensitivity to donor plasma proteins present in the blood product.
• Such reactions are managed acutely with antihistamines, hydrocortisone, and sometimes epinephrine. Allergic transfusion reactions can be minimized by reducing the plasma content of the blood products or by using "washed" red blood cells.

Hemolytic transfusion reactions

• rare, but can be life-threatening, with massive intravascular hemolysis due to complement-activating antibodies of immuno-globulin (Ig) M or IgG class, usually with ABO specificity. This type of immediate hemolytic reaction is usually due to the inadvertent transfusion of ABO-incompatible blood.
• Acute Hemolytic Transfusion Reaction

Blood screening

• Routine donor screening currently includes testing to exclude:
  • syphilis
  • hepatitis B, hepatitis C
  • HTLV-1 infection
  • HIV types 1 and 2 infection.
• Because all potential blood donors undergo the same screening process, there has not been shown to be any medical advantage to the use of directed donation (ie, recipient-specific) blood products in terms of decreasing the risk of viral transmission.
• With the current screening methods, in place since 1998, infection with HIV is estimated to occur less than once per 500,000 units of blood transfused.
   

References: Prep 2004

• Hoffbrand AV, Pettit JE, Moss PAH. Blood transfusion. In: Essential Haematology. 4th ed. Malden, Mass: Blackwell Science; 2001:307-318
• Kevy SV, Gorlin JB. Red cell transfusion. In: Nathan DG, Orkin SH, eds. Nathan and Oski's Hematology of Infancy and Childhood. 5th ed. Philadelphia, Pa: WB Saunders Co; 1998:1784-1801
• Simon TL. Blood and plasma services in the United States. In: Rossi EC, Simon TL, Moss GS, Gould SA, eds. Principles of Transfusion Medicine. 2nd ed. Baltimore, Md: Williams & Wilkins; 1996:863-869