see also: [[Massive blood transfusion]], [[Blood transfusion]] [Dunn -- complications of transfusion](x-devonthink-item://5D8CA993-7402-4930-8918-15E20FFC5958) [Rosen - acute transfusion reactions](x-devonthink-item://55975C5B-DFF3-4A3A-8A75-43D5E3F6F319?page=6&start=3047&length=27&search=Acute%20Transfusion%20Reactions) > [!Key Points] > - > - [mnemonic::] - A range of **acute transfusion reactions** need to be considered from common benign reactions, such as urticarial (1-3 %) and febrile nonhemolytic reactions (0.1-1%), to more unusual ones including anaphylaxis (1:50 000), fatal ABO incompatibility, and sepsis (1:500 000 000 with PRBC, 1:50000 with PLTs). - Children had a greater frequency of reactions than adults. - Potentially fatal reactions include TRALI, TACO, AHTR, sepsis, and anaphylaxis. **Febrile non-hemolytic transfusion reaction** – common reaction with fever, chills, and no other systemic symptoms; a diagnosis of exclusion – other more sinister causes including AHTR, sepsis, and TRALI may be the underlying cause. **Urticarial transfusion reactions** are associated with hives but no other allergic findings and are caused by an antigen-antibody interactions; the transfusion can be continued and symptomatic treatment provided. **Acute hemolytic transfusion reaction (AHTR) (1:76000)** — a life-threatening reaction caused by intravascular hemolysis of transfused red blood cells; due to clerical errors that results in an incorrect non-matched recipient. Symptoms include fever, chills, flank pain, and oozing from intravenous sites / wounds. Treatment involves aggressive hydration and diuresis. **Anaphylactic transfusion reaction** - allergic reactions other than hives including angioedema, wheezing, and/or hypotension. **Transfusion-associated circulatory overload (TACO) (<0.1%)** —a form of pulmonary edema due to volume excess where a large volume of a transfused product or underlying cardiovascular comorbidity result in pulmonary oedema. **Transfusion-associated sepsis** is caused by transfusion of a product that contains a microorganism. Treatment includes broad-spectrum antibiotics and hemodynamic support. **Transfusion-related acute lung injury (TRALI - <0.01%)** is a life-threatening reaction where recipient neutrophils are activated by the transfused product and fever, chills, and respiratory distress occur. Management is supportive. dysponea, cough, fever, pulm oedema. sx usually within 1-6 hours of starting transfusion # indications for special preparations of pRBCs ![[Pasted image 20240224202203.png]]