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Blood Transfusion Reactions: TACO, TRALI, and Other Considerations

While transfusion reactions are a relatively rare event (0.24% of blood product administrations in 2011), they can be life-threatening and are often difficult to differentiate in the acute setting. Diagnosis of an adverse reaction will be made clinically based upon vital signs and physical exam. For this reason, the uniform initial recommendation is to stop the transfusion for any reaction. This is followed by supportive care with attention to airway, breathing, and circulation.

Initial testing should include a repeat type and screen of both donor and recipient blood, direct antiglobulin (Coombs) test, urinalysis for hematuria, CBC, BNP, and blood cultures, +/- chest…

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  Transfusion Reactions In The ED

While the incidence of severe transfusion reactions is 0.09% (1/1111), the total incidence of all transfusion reactions is approximately 0.25% (1/400). Therefore, the likelihood that each emergency physician will see one is high, and we should all know the presentation, evaluation, and management of these complications.

 Severe Transfusion Reactions and their ED-focused management

The decision to transfuse blood is made based on the clinical combination of hemoglobin level, concurrent comorbidities, and the overall clinical picture. Once the decision is made, granted that our patient is stable and competent, it is our job to inform and consent the patient to receive blood. As a clinician, we run through the list of possibilities that can occur when receiving blood: fevers, allergic reactions, infections, lung injury, and possibly death. We explain that we try to minimize risks in every way possible; however, we must make the patient aware so that they understand the risks. But how rare are these adverse events, and how do we manage them?

 Tips on transfusion: Treating reactions and avoiding common errors

Patients are more likely to die from an accident on the expressway traveling to a hospital than from a blood transfusion once they're admitted, said Don Siegel, MD, PhD, during his Internal Medicine Meeting 2015 session on transfusion medicine. “You need to put these things in perspective when you're discussing transfusions' risks with patients,” said Dr. Siegel, who is a professor of pathology and laboratory medicine at the University of Pennsylvania in Philadelphia. Rare as they are, though, transfusion reactions do still occur...

Articles of Interest

Are transfusions harmful to men if the blood comes from women who have been pregnant?

Deaths resulting from transfusions are rare, but one cause can be transfusion-related acute lung injury. It has been linked to blood specifically from mothers, especially if the transfusion consisted not of red blood cells but plasma, the liquid portion of blood that contains antibodies. Pregnancy changes a woman’s circulating antibodies, as well as other characteristics of her immune system.

Adverse events related to blood transfusion

With universal leukoreduction of red blood cells (RBCs), selection of potential donors such as use of male donors only plasma and restriction of RBC storage, most of the non-infectious complications can be avoided.

Shining a Light on the Safety of Blood Transfusions

Kuehnert says the U.S. is one of the only developed countries not to have a national transfusion reporting and safety system.

Resources

Transfusion.com.au

Note that this is a guide only. You must follow your hospital guidelines.

Blood Bank Guy Podcast

Transfusions still harm, despite great reductions in transfusion-transmitted diseases. Assume all suspected reactions are hemolytic, and work to disprove your assumption.

The Royal Children's Hospital Melbourne

The most common immediate adverse reactions to transfusion are fever, chills and urticaria. The most potentially significant reactions include acute and delayed haemolytic transfusion reactions and bacterial contamination of blood products. During the early stages of a reaction it may be difficult to ascertain the cause.

Patient

Early complications of transfusion are rare, occurring in less than 1 in 1,000 transfusions, but tend to be more severe.

StatPearls

The most common signs and symptoms include fever, chills, urticaria (hives), and itching. Some symptoms resolve with little or no treatment. However, respiratory distress, high fever, hypotension (low blood pressure), and red urine (hemoglobinuria) can indicate a more serious reaction.