Cause: inhibited metabolism of bradykinin with infusion of bradykinin or activated prekallikrein
Treatment: stop transfusion, administer IV antibiotics, Gram stain to confirm contamination, culture bacteria, and treat complications
Cause: incompatibility of red cells causing rapid hemolysis of donor cells by preformed antibodies.
Prevention: strict adherence to donor collection protocols and storage requirements, do not issue units that have any abnormalities that could indicate contamination
Treatment: Slow or stop transfusion while antihistamines are administered. Same unit may be started again once antihistamines take effect.
Prevention: identify susceptible patients, infuse blood as slowly as possible, using small aliquots if necessary
Prevention: adhere to established blood bank standards
Cause: bacterial growth in stored unit causes sepsis in the recipient.
Treatment: stop transfusion, place patient upright, administer oxygen, start diuresis, and perform phlebotomy if necessary
Treatment: Stop transfusion if Sx manifest during transfusion, provide respiratory support and administer IV steroids.
Prevention: use leuko-reduced components
Prevention: use washed cells, for IgA-deficient patients with history of anaphylactic response to IgA, do not give products with IgA containing material
Cause: Abs to WBC HLA antigens or accumulated cytokines in unit
Treatment: oral calcium supplement for mild cases or IV calcium with monitoring in severe cases.
Prevention: decrease opportunity for human error
Cause: WBC antibodies in donor product react with the patient's WBCs. Leukoagglutination causes aggregates to become trapped in the lungs, causing pulmonary edema.
Treatment: withdraw ACE inhibition, avoid albumin volume replacement, avoid bedside leukocyte filtration
Treatment: document cause, rule out other causes of hemolysis, provide support if DIC occurs
Cause: transfusion of "whole blood" too rapidly in massive transfusion or to patients with impaired cardiac function, leading to circulatory overload and cardiopulmonary distress
Treatment: stop tranfusion, treat for hypotension, laryngeal edema, and bronchiolar constriction, position feet up, administer fluids, epinephrine, antihistamines, corticosteroids, beta-2-antagonists
Cause: blood hemolyzed due to improper storage, transfusion through a too-small needle, or contact with incompatible IV solutions.
Treatment: place patient on left side with legs elevated above chest and head
Cause: rapid citrate infusion (d/t citrated blood) causing lowered ionized calcium in circulation
Prevention: pretreat patient with antihistamines prior to transfusion
Treatment: stop tranfusion, keep IV open, treat shock, maintain airway, increase renal blood flow, monitor for DIC.
Treatment: use blood warmer
Cause: severe allergic reaction caused by antibodies to donor plasma proteins (such as anti-IgA)
Prevention: Donors with known leukoagglutinins should have their blood used only as washed RBCs. Some multiparous women have been excluded as plasma/plasma product donors in some parts of the world.
Cause: rapid infusion of cold blood
Treatment: antipyretics
Cause: non-severe allergy to donor plasma proteins
Cause: air infusion via line
