Transfusion reactions

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  1. Typing and cross matching – as a rule, Rh negative recipients should be transfused only with Rh negative blood; if the recipient is an elderly male who has not been transfused previously, the transfusion of Rh positive blood is reasonable if Rh negative blood is unavailable; Rh positive blood should not be used in Rh negative females of childbearing age
  2. Hemolytic reactions – incidence ~ 1:6000 units administered
    1. hemolytic reactions are characterized by intravascular destruction of red blood cells and consequent hemoglobinemia and hemoglobinuria
    2. symptoms: heat and pain, flushing, pain in the lumbar region, constricting chest pain
    3. treatment: stop transfusion, Foley catheter and massive hydration and alkalinization of urine with bicarbonate
  3. febrile nonhemolytic reactions occur in 1-4% of transfusions; symptoms are rash and fever within 1-6 hours of transfusion; caused by antibodies to the donor WBCs; treat with Tylenol
  4. allergic transfusion reaction – occurs in 1-3% and is caused by antibodies to plasma proteins; symptoms urticaria, pruritus, fever; treat with Benadryl and use washed RBCs in the future
  5. acute pulmonary injury – occurs in 1 in 5000 transfusions and is caused by leukocyte agglutination; donor antibodies to the WBCs bind the WBCs and form aggregates that get trapped in the lungs causing ARDS type picture; must use washed RBCs in the future
    1. gamma irradiation of blood helps prevent graft-versus-host disease
  6. transmission of disease: hepatitis .035%, HIV <.0001%
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