Transfusion reactions

• For all reactions (except minor allergic): stop transfusion; send remaining blood product and fresh blood sample to blood bank

• Acute hemolytic: fever, hypotension, flank pain, renal failure 24 h after transfusion

Due to ABO incompatibility — preformed Abs against donor RBCs Treatment: vigorous IVF. maintain UOP with diuretics, mannitol, or dopamine

• Delayed hemolytic: generally less severe than acute hemolytic; 5-7 d after transfusion

Due to undetected allo-Abs against minor antigens • anamnestic response Treatment: usually no specific therapy required: dx is important for future transfusion

• Febrile nonhemolytic: fever and rigors 0-6 h after transfusion

Due to Abs against donor WBCs and cytokines released from cells in blood product Treatment: acetaminophen • meperidine: rule out infection and hemolysis

• Allergic: urticaria; rarely, anaphylaxis: bronchospasm. laryngeal edema, hypotension

Reaction to plasma proteins in blood product: anaphylaxis is usually seen in IgA-

deficient Pts who have preformed anti-lgAAbs Treatment: urticaria — diphenhydramine; anaphylaxis — epinephrine • glucocorticoids

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