Transfusion reactions — what + how fast + how to treat
Differentiating transfusion reactions
Mnemonic device
Fast = bad
Mapping
Acute hemolytic
Mins-hours · ABO mismatch · fever, back/flank pain, dark urine, hypotension, DIC · STOP transfusion, IVF, mannitol/lasix for renal protection, alkalinize urine
Anaphylaxis
Mins · IgA deficient + IgA in donor plasma (rare) · hypotension, urticaria, bronchospasm · STOP, EPI, support
TRALI
Within 6h · donor anti-WBC antibodies · ARDS picture (bilateral infiltrates, hypoxia, normal CVP) · STOP, supportive ventilation, NO diuretics
TACO
Hours · volume overload · pulmonary edema, ↑ CVP, ↑ BNP · slow rate, diuretics, oxygen
FNHTR
1-6h · WBC antigens · fever 1-2°C, chills · STOP, antipyretic, leukoreduce future units
Allergic (urticaria)
Mins · plasma proteins · hives only, no hypotension · slow rate, antihistamine; can resume if mild
Clinical note: ALWAYS stop the transfusion at first sign of reaction — return bag to blood bank for testing. Differentiating TRALI vs TACO is critical: TRALI = no fluid overload, lung injury picture, NO diuretics; TACO = volume overload, IMPROVES with diuretics.