Question: A 55-year-old Man Is Admitted To The Emergency Department After A Motor Vehicle Accident. The Patient Is Hemorrhaging From A Lacerated Spleen And Requires Emergency Surgery. Pretransfusion Testing Determines That The Patient’s Phenotype Is Group A, D-negative Type With A Negative Antibody Screen. Crossmatches With Red Blood Cell Units Are Compatible …

CHAPTER 11 Adverse Complicati CHAPTER SUMMARY The major immune-mediated and non-immune-mediated adverse complications of transfusion Adverse Complications of Transfusion are summarized in the following table: CAUSE SIGNS AND SYMPTOMS CLINICAL TESTS Immune-mediated Hemolytic Acute: ABO incompatibility Fever, chills, pain, Delayed: Primary or second- hypotension ary alloimmunization Unexplained decrease in hemoglobin Recipient leukocyte antibod- Fever, chills, rigors ies, transfused cytokines Plasma allergen Rash, hives, flushing Febrile nonhemolytic Urticarial Positive DAT, eluate, serum antibody, elevat- ed plasma hemoglobin or bilirubin Rule out hemolysis, test for HLA antibodies None, responds to symp- tomatic treatment IgA antibody Anaphylactic Anti-IgA in IgA-deficient recipient Donor WBC antibodies Respiratory distress, hypotension Hypoxemia TRALI Posttransfusion Anti-HPA-1a or other purpura platelet antibody Bilateral infiltrates in chest x-ray Anti-HPA-1a antibody Thrombocytopenia (120% of pretransfu- sion count) Fever, rash, diarrhea TA-GVHD Immunocompetent donor lymphocytes to susceptible host Abnormal liver dys- function test, WBC chimerism Non-immune-mediated Hemolytic Mechanical or chemical trauma to unit Fever, chills, pain, hypotension Check blood adminis- tration needles, fluid, blood warmers Underlying cardiac or pulmonary pathology TACO Volume overload second- Respiratory distress, ary to rapid, high volume pulmonary edema, infusion cardiac failure Donor septicemia or contam- Fever, chills ination during phlebotomy Gram stain, culture of unit Bacterial infection