Nonhemolytic transfusion reactions

Published on 07/02/2015 by admin

Filed under Anesthesiology

Last modified 07/02/2015

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Nonhemolytic transfusion reactions

C. Thomas Wass, MD

Febrile reactions

Nonhemolytic transfusion reactions (NHTRs) often occur in patients receiving blood product transfusions. Fever is the most common NHTR, with a median frequency of 4%. Fever, defined as an increase in body temperature of 1°C or more during or within several hours of transfusion, usually persists for less than 12 h, is most often associated with transfusion of cellular components (e.g., red blood cells, platelets, and granulocytes), but has also been observed with transfusion of noncellular components (e.g., fresh frozen plasma or cryoprecipitate). Although the etiology has yet to be fully elucidated, it is hypothesized that recipient alloimmunization (i.e., antibody production in response to a previous transfusion or pregnancy) toward donor white blood cells or platelets triggers release of leukocyte-derived or platelet-derived pyrogenic cytokines (e.g., IL-1β, IL-6, IL-8, TNF-α, CD40L) that increase the hypothalamic thermoregulatory set point. Alternatively, fever may occur in response to direct transfusion of pyrogenic cytokines or other inflammatory mediators that accumulate during storage of blood products such that the greater the interval between collection and transfusion, the higher the frequency of febrile NHTR. However, prestorage leukocyte reduction (e.g., using leukocyte filtration techniques) mitigates transfusion-related fever.

Should the patient develop a fever while receiving a transfusion, the transfusion must be discontinued or slowed. Bacterial contamination (diagnosed via Gram stain and cultures) and hemolytic transfusion reaction (diagnosed via repeat crossmatch and direct Coombs test, which detects antibody to transfused donor red blood cells) should be ruled out. Antipyretic drugs (e.g., acetaminophen) may be used prophylactically or to treat febrile NHTRs; however, these medications may not prevent associated symptoms (e.g., chills, rigor, soreness at the transfusion site, headache, nausea, myalgia, chest tightness).

Mild allergic reactions

Mild allergic reactions are the second most common NHTR, occurring with a frequency of 0.5%. Signs and symptoms are usually mild and include urticarial rash and generalized pruritus as a result of IgE-mediated histamine release from degranulated mast cells and basophils in response to foreign substances (e.g., transfused plasma proteins) found in any plasma-containing blood products (especially platelets and fresh frozen plasma). Patients who do not show signs of having an anaphylactic reaction should be treated symptomatically with diphenhydramine, and the transfusion may be continued.

Anaphylactic reactions

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