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Fever
Chills, rigors
Pain: lower back, flanks, chest, along infusion vein
Dark urine
Oliguria
Hypotension
DIC
Renal failure
Laboratory findings:
Hemoglobinemia
Hemoglobinuria
Positive Direct Antiglobulin Test
Indirect hyperbilirubinemia
Low serum haptoglobin
Management
STOP TRANSFUSION
Remove blood unit, maintain IV access, change IV line
Supportive approaches
Monitor and maintain vital signs
Give normal saline Intravenous crystalloids (NaCl 0,9% 1020 mL/kg)
Maintain renal perfusion:
Furosemide 12 mg/kg/dose (IV) maintain diuresis > 1 mL/kg/hour
Dopamine (15 g/kg/min) for hypotension
FFP, thrombocyte, cryoprecipitate for DIC with bleeding
Workup
Check patient identity and label
Check blood and urine:
Direct antiglobulin test (DAT)
Repeat crossmatch & blood group typing
Urinalysis
Bilirubin serum, haptoglobin serum
Renal status: diuresis, BUN, creatinine
Blood culture
Send remaining blood to PMI
Make report (medical record & PMI)
FTNR (Febrile nonhemolytic transfusion reaction)
Rise in patient temperature >1C (associated with transfusion without other etiologic factors)
Caused by alloantibodies directed against HLA antigens
Occur during transfusion or within 6 hours after transfusion
Need to evaluate for AHTR and infection
RBC transfusion: 0.5-5%
Platelet transfusion: 1-38%
Risk factors:
Recurrent transfusion
History of FNHTR
Hematology/oncology patient
Older age (FNHTR due to platelet transfusion in children 5-20%, in adult 18-38%)
Mechanism:
Activation of recipient leukocytes and endothelial cells by transfused donor leukocytes or plasma
constituents, or by the passive transfer of cytokines that accumulated in the unit during storage
Clinical Features
Fever after 30-90 min
+ Rigors
+ Headache
No Hypotension
No Bronchospasm
No flank pain
No haemoglobinaemia
No Haemoglobinuria
Management:
STOP TRANSFUSION
Use of Antipyreticsresponds to Tylenol
Use of Corticosteroids for severe reactions
Use of Narcotics for shaking chills
Future considerations
May prevent reaction with leukocyte filter
Use single donor platelets
Use fresh platelets
Washed RBCs or platelets
Clinical Features
Mild / Skin-restricted:
Pruritus, Uerticaria, No fever or Hypotension
Severe / Systemic ( Anaphylaxis):
As above plus:
Fever
Hypotension
Bronchospasm, Angioedema
Management
Mild / Skin-restricted :
Stop transfusion temporary
Anti-histamines
Resume Transfusion
Clinical Features
Fever, chills
Acute Respiratory Distress
Normal CVP (Central Venous Pressure)
CXR: Pulmonary Infiltrate
Management
Cardio-Pulmonary Support
Steroids
Diuretics of No value
Mortality : high
TACO
Management
Diuretics
Consider haemodialysis
Supportive
Prevention
Never exceed 2-3 ml/kg/hourunless ongoing bleeding
Pre-medicate with diuretics in cardiac or severely anemic patients