Expansion
Acute haemolytic, febrile, allergic, TACO and TRALI
Expansion
Immediate
- Acute haemolytic: ABO incompatibility, almost always a clerical error. Fever, loin pain, hypotension, haemoglobinuria, disseminated intravascular coagulation. Stop immediately
- Febrile non-haemolytic: donor leucocyte cytokines. Common and benign; slow or stop and give an antipyretic
- Allergic or anaphylactic: plasma proteins; anaphylaxis is classic in IgA deficiency with anti-IgA antibodies
- Bacterial contamination: rapid fever and shock, commonest with platelets, which are stored at room temperature
- TACO (transfusion-associated circulatory overload): volume overload with hypertension, raised JVP and response to diuretics
- TRALI: donor antibodies against recipient leucocytes causing non-cardiogenic pulmonary oedema within 6 hours, with hypotension and a normal JVP
Delayed
- Delayed haemolytic reaction, post-transfusion purpura, graft versus host disease, iron overload, transmitted infection
TACO is now the commonest cause of transfusion-related death, and is largely preventable by transfusing single units slowly with diuretic cover in those at risk.