Transfusion Reactions Follow-up

Updated: Jul 20, 2016
  • Author: S Gerald Sandler, MD, FACP, FCAP; Chief Editor: Emmanuel C Besa, MD  more...
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Follow-up

Deterrence/Prevention

Persons known to have formed red cell alloantibodies as the result of previous transfusions or pregnancy should be informed and provided with a written report that lists the antibodies to be presented to the transfusion service if additional transfusions are required at another hospital.

Ask patients scheduled for red cell transfusions about any history of previous transfusions and if they are aware of any complications or blood bank antibody problems.

Obtain details of any previous transfusions during the medical history or when obtaining the patient's informed consent for a transfusion.

In cases of transfusion reaction, retype the donor and recipient RBCs. A discrepancy between the original ABO type and the repeat ABO typings should raise the urgent question of whether a mix-up of blood samples could place another patient at risk of a similar mismatched transfusion.

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Complications

Acute hemolytic reactions (antibody mediated): Renal failure and DIC are potential complications for patients who survive the initial acute reaction.

Acute hemolytic reactions (non–antibody mediated): Transfusion of serologically compatible but hemolyzed red cells results in acute hemoglobinemia and hemoglobinuria. Rarely, short- or long-term complications occur.

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Prognosis

Acute hemolytic reactions (antibody mediated): Most severe and fatal reactions result from inadvertent transfusion of group AB or group A red cells to a group O recipient.

Acute hemolytic reactions (non–antibody mediated) are typically benign.

Nonhemolytic febrile reactions are discomforting but typically benign.

Allergic reactions are benign but bothersome to recipients.

Anaphylactic reactions are potentially, but rarely, fatal.

TRALI: In one study, 78% of patients with TRALI required initiation of mechanical ventilation, 25% required initiation of vasopressors, and 17% died; however, the researcher concluded that underlying risk factors for acute lung injury may have had the principal influence on clinical outcomes. [58] Early and intensive pulmonary support reduces the risk of a fatal outcome.

Circulatory (volume) overload: The outcome varies with the overall clinical status of the patient.

Bacterial contamination/endotoxemia is potentially fatal and may be caused by gram-positive or gram-negative bacteria. Early diagnosis, initiation of broad-spectrum antibiotics, and other intensive supportive measures may reverse the outcome of an otherwise fatal complication of transfusion.

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