The Resident on Duty decided to transfuse the patient with 2 units of packed red blood cells (PRBCs)

PRBC

Immune-Mediated Reactions
Acute Hemolytic Transfusion Reactions preformed antibodies that lyse donor erythrocytes. The ABO isoagglutinins are responsible for the majority of these reactions Acute hemolytic reactions may present hypotension tachypnea tachycardia Fever chills hemoglobinemia hemoglobinuria chest and/or flank pain discomfort at the infusion site

Errors at the patient's bedside, such as mislabeling the sample or transfusing the wrong patient

mild urticaria (hives) and pruritus to severe shock and death

Symptoms and signs include difficulty breathing, coughing, nausea and vomiting, hypotension, bronchospasm, loss of consciousness, respiratory arrest, and shock

immediate hypersensitivity type of immune system response

IgA deficiency

Anaphylactic Reaction

Febrile Nonhemolytic Transfusion Reaction (FNHTR)

FNTHR

diagnosed when other causes of fever in the transfused patient are ruled out.
Antibodies directed against donor leukocyte and HLA antigens may mediate these reactions

most frequent reaction associated with the transfusion of cellular blood components

characterized by chills and rigors and a 1C rise in temperature.

American Association of Blood Banks (AABB)Technical Manual defines FNHTR as a 1C temperature rise associated with transfusion and having no medical explanation other than blood component transfusion

The leukocyte antibodies are commonly directed against antigens present on monocytes, granulocytes,or lymphocytes

TransfusionRelated Acute Lung Injury

acute respiratory distress, either during or within 6 h of transfusing the patient. characterized by chills, cough, fever, cyanosis, hypotension, and increasing respiratory distress shortly after transfusion of blood component volumes that usually do not produce hypervolemia leukocyte antibodies in donor or patient plasma

Nonimmunologic Reactions
Bacterial Contamination Reactions

Clinical signs and symptoms

fever and chills, which can progress to septic shock and DIC.

appear rapidly during transfusion or within about 30 minutes after transfusion

(CDC), most are caused by blood components contaminated by Yersinia enterocolitica

this type of reaction is termed warm and is characterized by dryness and flushing of the patients skin

Fluid Overload

(transfusion-associated circulatory overload, TACO) Blood components are excellent volume expanders -> Fluid overload iatrogenic (physician-caused) transfusion reaction. congestive heart failure and pulmonary edema dyspnea, coughing, cyanosis, orthopnea, chest discomfort, headache, restlessness, tachycardia, systolic hypertension (greater than 50mmHg increase), and abnormal electrocardiogram results.

Electrolyte Toxicity
RBC leakage during storage increases the concentration of potassium in the unit.

Hypocalcemia
manifested by circumoral numbness and/or tingling sensation of the fingers and toes, may result from multiple rapid transfusions.

Citrate, commonly used to anticoagulate blood components

rapidly infused

Refrigerated (4C) or frozen ( 18C or below) blood components

Cardiac dysrhythmias

Hypothermia