Transfusion reactions

Acute Hemolytic Transfusion Reaction Caused by ABO incompatibility Immediate onset Initial symptoms: chills, fever, nausea Can progress to: hemoglobinuria, bleeding, hypotension Diagnosis: positive direct Coombs test, hemolysis markers Note: symptoms often masked under anesthesia Non-Hemolytic Febrile Transfusion Reaction Most common reaction (0.5% of RBC, up to 30% of platelet transfusions) Caused by recipient antibodies against donor leukocyte HLA antigens Symptoms: fever, chills, headache, myalgia, nausea, cough Treatment: acetaminophen, diphenhydramine Prevention: leukoreduced/fresh blood products Delayed Hemolytic Transfusion Reaction Occurs 2-21 days post-transfusion More common in previously pregnant women Due to antibodies against minor antigens (Rh, Kidd) Presents as unexpected hemoglobin drop Transfusion-Related Acute Lung Injury Leading cause of transfusion-related deaths in US Immune-mediated lung injury Risk reduced by restricting female donors of childbearing age for plasma