Allergic transfusion reaction
An allergic transfusion reaction is a blood transfusion that results in allergic reaction. It is among the most common transfusion reactions to occur. Reported rates depend on the degree of active surveillance versus passing reporting to the blood bank[1]. Overall, they are estimated to complicate up to 3% of all transfusions[2]. The incidence of allergic transfusion reactions is associated with the amount of plasma in the product[2]. More than 90% of these reactions occur during transfusion.
An allergic transfusion reaction is a type of transfusion reaction that is defined according to the Center for Disease Control (CDC) [3]as:
DEFINITIVE DIAGNOSIS:
2 or more of the following occurring during or within 4 hours of cessation of transfusion:
- Conjunctival edema
- Edema of lips, tongue and uvula
- Erythema and edema of the periorbital area
- Generalized flushin
- Hypotension
- Localized angioedema
- Maculopapular rash
- Pruritus (itching)
- Respiratory distress; bronchospasm
- Urticaria (hives)
PROBABLE DIAGNOSIS:
Any 1 of the following occurring during or within 4 hours of cessation of transfusion:
- Conjunctival edema
- Edema of lips, tongue and uvula
- Erythema and edema of periorbital area
- Localized angioedema
- Maculopapular rash
- Pruritus (itching)
- Urticaria (hives)
Treatment
Treatment of an allergic transfusion reaction is to STOP the transfusion. If the only symptoms are mild (ie, hives and itching), the patient may be treated with an antihistamine and if the symptoms completely disappear and the patient feels well, the transfusion may be restarted. A mild transfusion reaction during infusion usually does not progress to a more severe anaphlyactic reaction after infusion of additional product from the same unit[2]. If the symptoms are more than mild, the transfusion should not be restarted.
Prevention
There is no evidence that antihistamine premedication prevents allergic transfusion reactions, although these drugs can mitigate symptoms once they occur[4][5][2].
- ^ Savage WJ, Tobian AA, Savage JH, Wood RA, Schroeder JT, Ness PM (June 2013). "Scratching the surface of allergic transfusion reactions". Transfusion. 53 (6): 1361–71. doi:10.1111/j.1537-2995.2012.03892.x. PMC 3711222. PMID 22998777.
- ^ a b c d Savage WJ (June 2016). "Transfusion Reactions". Hematology/Oncology Clinics of North America. 30 (3): 619–34. doi:10.1016/j.hoc.2016.01.012. PMID 27113000.
- ^ "CDC NHSN Biovigilance Component: Hemovigilance Module Surveillance Protocol v2.5.2".
{{cite web}}: Cite has empty unknown parameter:|dead-url=(help) - ^ Wang SE, Lara PN, Lee-Ow A, Reed J, Wang LR, Palmer P, Tuscano JM, Richman CM, Beckett L, Wun T (July 2002). "Acetaminophen and diphenhydramine as premedication for platelet transfusions: a prospective randomized double-blind placebo-controlled trial". American Journal of Hematology. 70 (3): 191–4. doi:10.1002/ajh.10119. PMID 12111764.
- ^ Kennedy LD, Case LD, Hurd DD, Cruz JM, Pomper GJ (November 2008). "A prospective, randomized, double-blind controlled trial of acetaminophen and diphenhydramine pretransfusion medication versus placebo for the prevention of transfusion reactions". Transfusion. 48 (11): 2285–91. doi:10.1111/j.1537-2995.2008.01858.x. PMID 18673350.