Presentation
Patients present with an unexpected temperature rise (≥38ºC or ≥1ºC above baseline, if baseline ≥37ºC) during or shortly after transfusion. This is usually an isolated finding. Occasionally the fever is accompanied by chills. [transfusion.com.au]
Circulating immune complex, HLA, and platelet antibodies were not present. The granulocyte antibodies fluctuated in titers with disease activities, and could be completely removed from the serum by autologous granulocyte absorption. [ncbi.nlm.nih.gov]
Presents as respiratory distress and noncardiogenic pulmonary edema. [errolozdalga.com]
It may present with only mucocutaneous signs and symptoms. An allergic reaction may present in a spectrum ranging from mild urticaria to anaphylaxis. [fairview.org]
Pathogenesis and Clinical Presentation The clinical presentation of the different types of blood transfusion reactions varies depending on the pathogenic mechanism. [learn.pediatrics.ubc.ca]
Entire Body System
- Fever
Occasionally the fever is accompanied by chills. [transfusion.com.au]
(see Fever, [[Fever]]) Treatment Stop the Transfusion : usually resolves without sequelae Rule Out a Acute Hemolytic Transfusion Reaction (see Acute Hemolytic Transfusion Reaction, [[Acute Hemolytic Transfusion Reaction]]) Anti-Pyretics : aspirin should [mdnxs.com]
(mostly associated with pRBCs) Clinical features Fever; may be accompanied by chills, rigors, cold and discomfort No complications but costs time and money to rule out more serious transfusion reactions Diagnosis Must exclude all causes for fever, such [pathologyoutlines.com]
The UK hemovigilance system (SHOT) categorizes the severity of the reaction.[6] Mild[edit] Fever of at least 38oC/100.4oF oral and a change of between 1 and 2oC from pre-transfusion values but no other symptoms or signs[6] Moderate[edit] Fever of at least [en.wikipedia.org]
- Chills
Occasionally the fever is accompanied by chills. [transfusion.com.au]
[…] infection, bacterial contamination of the blood component, or another type of transfusion reaction e.g. acute hemolytic transfusion reaction.[4] Fever must be at least 38oC/100.4oF oral and a change of at least 1oC/1.8oF from pre-transfusion value OR chills [en.wikipedia.org]
Chills may precede the fever or occur up to 30 minutes after the onset of fever. In some patients, headache, flushing, or tachycardia may accompany fever and chills. [clinlabnavigator.com]
Transfusion Reaction (see Acute Hemolytic Transfusion Reaction, [[Acute Hemolytic Transfusion Reaction]]) Anti-Pyretics : aspirin should be avoided in the setting of thrombocytopenia Meperidine (Demerol) (see Meperidine, [[Meperidine]]): for severe chills [mdnxs.com]
Because fever and chills also herald a severe hemolytic transfusion reaction, all febrile reactions must be investigated as with any transfusion reaction. [openanesthesia.org]
- Rigor
[…] a change of between 1 and 2oC from pre-transfusion values but no other symptoms or signs[6] Moderate[edit] Fever of at least 39oC, OR a rise in temperature of at least 2oC from pre-transfusion values AND/OR other symptoms or signs, including chills (rigors [en.wikipedia.org]
These antigens are present on donor lymphocytes, granulocytes, or platelets.(1,2) Investigation Clinically assess the transfused patient for fever, chills, rigors and headache. Acute haemolytic reaction may need exclusion. [transfusion.com.au]
[…] contaminating leukocytes remain functional); or (b) recipient WBC antibodies against leukocytes transfused → antigen - antibody complex → release of endotoxin → fever (mostly associated with pRBCs) Clinical features Fever; may be accompanied by chills, rigors [pathologyoutlines.com]
Meperidine (Demerol) may be helpful in treating rigors. Only 1 in 7 patients experiencing a febrile nonhemolytic reaction will have another reaction at their next transfusion. [clinlabnavigator.com]
- Malaise
[…] and fatigue R53.0 Neoplastic (malignant) related fatigue R53.2 Functional quadriplegia R53.8 Other malaise and fatigue R53.82 Chronic fatigue, unspecified Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD- [icd10data.com]
[…] in pediatric population Onset 1-2 hours after transfusion Fever Chills, rigors, malaise Headache Nausea/ vomiting Increase in diastolic BP Allergic transfusion reaction Inflammatory reaction resulting in release of histamine by mast cells Most common [learn.pediatrics.ubc.ca]
Onset during or within 1–6 hours after transfusion Clinical features: fever, chills, malaise Cessation of transfusion until an acute hemolytic transfusion reaction has been ruled out Treat with acetaminophen; recurrence uncommon Minor allergic reactions [amboss.com]
The symptoms developed by the recipient include fever, chills, headache, muscle aches, and malaise. A thick blood film is necessary to confirm the diagnosis. [hindawi.com]
- Puerperal Pyrexia
Excludes chills without fever ( R68.83 ) febrile convulsions ( R56.0- ) fever of unknown origin during labor ( O75.2 ) fever of unknown origin in newborn ( P81.9 ) hypothermia due to illness ( R68.0 ) malignant hyperthermia due to anesthesia ( T88.3 ) puerperal [icd10data.com]
Cardiovascular
- Tachycardia
The most common of these was tachycardia (37.8%). [academic.oup.com]
Hemolytic reactions: hypotension, tachycardia, hemoglobinuria and microvascular bleeding due to administration of ABO-incompatible blood transfusions can be life-threatening. [enotes.tripod.com]
Fever, chills, sweats Warm or clammy skin Vomiting Rash Tachycardia, tachypnea Hypothermia Delayed haemolytic transfusion reaction Allo-immunization to other antigens. [learn.pediatrics.ubc.ca]
A patient will start to look pale, feel weak, experience shortness of breath with activity, and tachycardia (heart has to work harder) etc. [youtube.com]
The patient will present with respiratory distress, tachycardia, hypertension, acute or worsening pulmonary oedema and a positive fluid balance (Australian Red Cross Blood Service 2017; Crisp & Taylor 2012). [ausmed.com]
Neurologic
- Quadriplegia
[…] elsewhere R50.82 Postprocedural fever R50.83 Postvaccination fever R50.84 Febrile nonhemolytic transfusion reaction R50.9 Fever, unspecified R52 Pain, unspecified R53 Malaise and fatigue R53.0 Neoplastic (malignant) related fatigue R53.2 Functional quadriplegia [icd10data.com]
- Excitement
Includes a wealth of information on the exciting subject of omics ; these extraordinarily complex measurements reflect important changes in the body and have the potential to predict the onset of diseases such as diabetes mellitus. [books.google.com]
Workup
Consequently, the additional cost to our institution for each laboratory workup alone would have been the following: (141 − 104 FNHTRs) × $75 per workup = $2775. [archivesofpathology.org]
Provide supportive care to patient while initiating a TR workup. [clinicaladvisor.com]
(Note: Any positive direct AGT requires further evaluation by the blood bank or a red cell reference laboratory for an antibody workup, and a positive culture or evidence of hemolysis must be reported immediately to the clinician). [path.upmc.edu]
Because fever can be a sign of either type of reaction, the transfusion should be stopped and a workup should be completed if a patient's temperature increases by 1 °C during a transfusion. Patients can also have allergic reactions to transfusions. [acphospitalist.org]
Awareness of DHTR in particular for the patient at risk can limit wastage of scarce resources by the patient and the medical, nursing, and laboratory personnel in “septic workup” [25]. [hindawi.com]
Serum
- Erythroblast
WBC 13.1 × 10 9 /L platelet count 953 × 10 9 /L erythroblasts 12.7% of nucleated cells. [bloodjournal.org]
WBC 13.1 × 109/L platelet count 953 × 109/L erythroblasts 12.7% of nucleated cells. [ashpublications.org]
Treatment
[…] and management Stop the transfusion Notify the transfusion medicine service Rule out other causes, such as hemolysis (DAT, visual check for hemoglobinemia), bacterial contamination (culture the product if necessary) Symptomatic treatment: acetaminophen [pathologyoutlines.com]
admission to hospital, or lengthens the duration of hospital admission[6] Treatment[edit] Paracetamol has been used in treatment, and leukoreduction of future transfusions is sometimes performed.[7] References[edit] External links[edit] Classification [en.wikipedia.org]
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Alternatively, FNHTR can be mediated by pre-formed cytokines in the donor plasma as a consequence of white blood cell breakdown. [1] [2] It is abbreviated "FNHTR". [3] Acetaminophen has been used in treatment, and leukoreduction of future transfusions [ipfs.io]
Prognosis
Transfusion-associated GVHD carries a very poor prognosis; it is fatal in over 90% of cases [47]. Gamma irradiation of cellular blood components is the recommended method of preventing this complication [50]. [hindawi.com]
After the acute phase, the degree of acute kidney injury determines the prognosis. Diuresis and a decreasing BUN usually portend recovery. Permanent renal insufficiency is unusual. Prolonged oliguria and shock are poor prognostic signs. [merckmanuals.com]
Etiology
The etiologies of the other associated symptoms remain unclear. [academic.oup.com]
Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'. [icd10data.com]
There is, however, enough evidence to warrant permanent deferral of a donor whose donated unit is frequently implicated in the etiology of TRALI [45]. 8. [hindawi.com]
Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. Blood. 2003 Jan 15. 101(2):454-62. [Medline]. [Full Text]. Blajchman MA. [medscape.com]
The exact etiology is unclear. However, the most accepted hypothesis is that a patient who is negative for human platelet antigen 1a (HPA1a) develops alloantibodies due to exposure to HPA1a antigen from the fetus during pregnancy. [merckmanuals.com]
Epidemiology
Epidemiology Incidence : most common type of transfusion reaction Physiology Mechanism : believed to be associated with class I HLA antibodies (or sometimes granulocyte specific antibodies) directed against the contaminating leukocytes in the transfused [mdnxs.com]
Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014 ; 133 : 291 - 307. 13.. Epidemiology and risk factors for drug allergy. Br J Clin Pharmacol. 2011 ; 71 : 684 - 700. 14.. [academic.oup.com]
Methods A retrospective epidemiological study was conducted with a quantitative approach. [scielo.br]
Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. Blood. 2003 Jan 15. 101(2):454-62. [Medline]. [Full Text]. Blajchman MA. [emedicine.medscape.com]
Pathophysiology
Definition / general Increase of > 1 degree Centigrade associated with transfusion, without hemolysis, that cannot be attributed to other causes (diagnosis of exclusion) Usually occurs within 2 hours of transfusion Pathophysiology Associated with leukocytes [pathologyoutlines.com]
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A good understanding of the pathophysiology of the differential diagnoses is indispensable to the correct evaluation of fever in blood transfusion. [hindawi.com]
Acute hemolytic transfusion reaction, a paradigm of the systemic inflammatory response: new insights into pathophysiology and treatment. Transfusion. 1995 Jun. 35(6):513-20. [Medline]. Davenport RD. [emedicine.medscape.com]
Prevention
Transfusion. 2008;48(11):2285 [ MEDLINE ] Leukoreduction for the prevention of adverse reactions from allogeneic blood transfusion. Cochrane Database Syst Rev. 2015 Dec 3;12:CD009745. doi: 10.1002/14651858.CD009745.pub2 [ MEDLINE ] [mdnxs.com]
Premedication of the patient with an antipyretic drug, paracetamol in the UK and acetaminophen in North America, has become standard practice to prevent FNHTRs. [onlinelibrary.wiley.com]
We conclude that pretransfusion testing of group 0 donors and recipients for isohemolysins combined with platelet crossmatching may prevent febrile reactions. [ncbi.nlm.nih.gov]
This can be prevented by the use of Rho(D) immune globulin, commonly known as RhoGAM. [library.med.utah.edu]