| name: | Blood Transfusion Reaction |
| also known as: | Blood Allergy; Serum Sickness; Transfusion Reaction; Hemolytic Transfusion Reaction; ABO Reaction; ICD 999.8 |
| also see: | Shock; Hemolytic Anemia; Rh Incompatibility; ABO Blood Typing |
| description: | Blood transfusion reaction is a reaction triggered by a transfusion of blood, much more common with unmatched blood, but still possible with matched blood, risk increasing with emergency situations, human error, infected donor blood and the need for multiple transfusions. Blood transfusion reaction is one type of serum sickness. The person receiving the blood or the recipient's immune system, reacts to the donor blood, destroying the blood by hemolysis, or just acting to the increased burden of "foreign" protein. Many blood transfusion reactions are not to the red blood cells but to the white blood cells (leukocytes). Since most transfusions are administered for the need of the red blood cells or platelets, not for the white blood cells, filtering out the white blood cells can be performed but is more costly. Blood transfusion reactions can be classified into three main types: 1. Red Blood Cell ABO incompatibility: This is an incompatibility to the red blood cells, divided into 4 divisions (A, B, AB, O) where the person's immune system launches a hemolytic event similar to hemolytic anemia. 2. White Blood Cell incompatibility: This is an immune reaction by the person's immune system to the white blood cells (leukocytes) and other proteins in the blood plasma (platelets, immunoglobulin, etc.) and forms the basis of "serum sickness." 3. Rh incompatibility: This is an incompatibility to the red blood cells, divided into 2 division (Rh+, Rh-) where an Rh incompatibility reaction can occur. |
| signs & symptoms: | Chills and fever during the transfusion, chills, followed by muscle aches and pains, backache, rash, hives, dark urine, itching, shortness of breath, severe headache, chest pain and back pain, anxiety, flushing. Hemolysis leads to hemolytic anemia and jaundice. If a patient is under general anesthesia and receives a blood transfusion, if they develop a blood transfusion reaction, the signs and symptoms might be masked. |
| diagnosis: | History of a transfusion plus signs, symptoms, physical exam, blood count, blood chemistry and a blood test to evaluate blood match (in)compatibility. Differential diagnosis includes: acute kidney infection, bacteremia, heart attack, abdominal pain differential, autoimmune disease, hemoglobinopathy. |
| treatment: | Stop transfusion immediately if symptoms begin during the transfusion. IV hydration and osmotic diuretics such as mannitol or loop diuretics such as furosemide (lasix) to prevent acute renal failure. Other treatment varies from antihistamines to relieve itching, prednisone to help prevent acute renal failure. Shock and DIC if they develop are treated accordingly. |
| prevention: | Blood banking errors need to be avoided and patients need to tell health care providers of any previous reaction to a blood transfusion. |
| outcome: | Most reactions run their course and resolve completely with time and treatment. A few cases can result in acute renal failure, DIC and anaphylaxis. |
skynetMD suggests the following:
| if: | If the person who recently had a transfusion develops severe reaction symptoms, such as shortness of breath, severe headache, chest and back pain, blood in the urine, called hematuria |
| go to: | Go to the hospital for emergency care |
| if: | If the person who recently had a transfusion develops milder symptoms such as fever, chills, backache, hives, itching |
| go to: | Go to the doctor |
Last updated 9/16/2007