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Acute transfusion reactions

Definition
Acute transfusion reactions are adverse reactions that occur during or within the first 24 hours of transfusion of blood and blood components.
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Pathophysiology
Acute transfusion reactions are caused by non-immunological reactions resulting from physical and chemical properties of the transfused blood component and by immunological reactions due to transfused erythrocyte, leukocyte, platelet, and plasma proteins.
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Epidemiology
Acute transfusion reactions in the US are reported in 282 cases of 100,000 units of transfusions, with 4.7 of these being life-threatening.
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Disease course
The clinical manifestations depend on the type of transfusion reaction, which include acute hemolytic transfusion reaction, febrile non-hemolytic transfusion reaction, anaphylactic transfusion reaction, minor allergic transfusion reaction, transfusion-related acute lung injury, transfusion-associated circulatory overload, massive transfusion-associated complications, septic transfusion reaction, and acute pain transfusion reaction. Symptoms vary from fever, chills, headache, anxiety, transient hypertension, discomfort, dyspnea, kidney pain, hemoglobinuria, pruritus, urticaria, jaundice, hypotension, tachycardia, tachypnea, pain, nausea, acute respiratory distress, elevated natriuretic peptide, elevated central venous pressure, left HF, positive fluid balance, radiological evidence of pulmonary edema, DIC, acute renal failure, shock and even death.
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Prognosis and risk of recurrence
Acute transfusion reactions can lead to significant morbidity and mortality; therefore, early symptoms and signs of acute reactions to transfusion of blood and its products should be carefully monitored.
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Key sources
The following summarized guidelines for the evaluation and management of acute transfusion reactions are prepared by our editorial team based on guidelines from the British Society for Haematology (BSH 2023).
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Guidelines

1.Diagnostic investigations

Clinical assessment: ask patients to report symptoms developing following the completion of transfusion.
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  • Laboratory tests

  • CXR

2.Medical management

General principles: direct initial treatment of acute transfusion reactions according to symptoms and signs. Do not delay treatment of severe reactions until the results of investigations are available.
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  • Intramuscular epinephrine

  • Antipyretics

  • Antihistamines

  • Corticosteroids

3.Therapeutic procedures

Discontinuation of transfusion: discontinue transfusion temporarily but maintain venous access in patients developing new symptoms or signs during transfusion.
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4.Specific circumstances

Patients with immunoglobulin A deficiency: discuss the future management of patients with IgA deficiency diagnosed after acute transfusion reactions with a specialist in transfusion medicine.
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5.Preventative measures

Secondary prophylaxis: administer a trial of premedication with oral acetaminophen given 1 hour before the anticipated reaction in patients with recurrent febrile reactions (or NSAIDs in patients with predominant chills or rigors, always accompanied by an individualized assessment of the risks of medication against the severity of reaction).
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