Question

A 55-year-old man is admitted to the emergency department after a motor vehicle accident. The patient is hemorrhaging from a lacerated spleen and requires emergency surgery. Pretransfusion testing determines that the patient’s phenotype is group A, D-negative type with a negative antibody screen. Crossmatches with red blood cell units are compatible by the immediate-spin crossmatch. During surgery, the patient receives 6 units of group A, D-negative red blood cells and 4 units of group A frozen plasma. Three days later, during the first 15 minutes of a subsequent red blood cell transfusion using a blood-warming device, the patient develops fever and chills.

1. Based on the information provided, propose three possible explanations for the cause of the transfusion reaction.

2. Determine a strategy for the evaluation of the transfusion reaction to rule in or rule out any possible mechanism.

Answer 1

The transfusion reaction occurs after 3 days so this type of reaction is classified as delayed transfusion reaction.

This may be due to:

DELAYED HAEMOLYTIC TRANSFUSION REACTION(DHTRs)

This occurs due to the reactivation of pre-existing antibodies against antigens on the transfused red cells.

This may be due to crossmatched compatible RBCs.

Treatment

This type of reaction doesn't require any specific treatment as red cell destruction occurs gradually as antibody synthesis occurs.

TRANSFUSION RELATED ALLERGIC REACTION

URTICARIA

• Mildest form
• Causes rashes and itching

TREATMENT

• Stop transfusion
• When the symptoms subside the transfusion may be resumed
• Severe reactions managed with 125 mg iv methylprednisolone or 50 mg orally prednisolone

TRANSFUSION ASSOCIATED GRAFT VS HOST DISEASE REACTION

• Clinically characterized by fever and rash
• This occurs after transfusion from a blood related homozygous donor to a heterozygous recipient.

2^nd part

Stepwise evaluation of the transfusion reaction

1. Stop the transfusion.
2. Replace the infusion set.
3. Keep administer normal saline through iv.
4. Immediately notify the doctor and blood bank.
5. Send fresh samples of blood for lab investigation like ABG, antibody IgA level, CBC, blood culture, renal and liver function.
6. Administer antihistamine IM and oral antipyretic.
7. Give iv corticosteroids and bronchodilators in severe allergic reactions.
8. Send urine sample for the next 24 hrs for lab testing..
9. If clinical improvement seen ,resume transfusion slowly with a new blood unit.