Allergic (Hypersensitivity) Transfusion Reactions
Allergic transfusion reactions are typically type I hypersensitivity reactions to donor plasma proteins. (isbtweb.org)
Clinical manifestations range from localized urticaria/pruritus to severe anaphylaxis with airway and/or cardiovascular compromise. (isbtweb.org)
Clinical Signs and Symptoms
Mild allergic transfusion reaction
- Localized skin rash and/or urticaria with pruritus without systemic features. (isbtweb.org)
Severe allergic transfusion reaction / anaphylaxis
- Urticaria and other mucocutaneous findings plus systemic involvement. (isbtweb.org)
- Respiratory findings such as throat tightness, bronchospasm, wheezing, and stridor. (isbtweb.org)
- Cardiovascular findings such as hypotension and cardiorespiratory collapse. (isbtweb.org)
- Angioedema, sometimes preceded by tingling around the face and lips. (isbtweb.org)
Pathophysiology
Allergic transfusion reactions are typically type I hypersensitivity reactions to donor plasma proteins. (isbtweb.org)
The implicated allergen is rarely identified. (isbtweb.org)
Severe reactions represent anaphylaxis, a life-threatening hypersensitivity reaction requiring immediate treatment. (isbtweb.org)
Immediate Assessment and Stabilization
- Transfusion should be stopped temporarily when new symptoms/signs occur during transfusion. (b-s-h.org.uk)
- Venous access should be maintained while assessment proceeds. (b-s-h.org.uk)
- Vital signs should be monitored (pulse, blood pressure, temperature, respiratory rate). (b-s-h.org.uk)
- Assess for airway, breathing, and circulation compromise because rapidly developing airway/breathing/circulation problems with skin or mucosal change suggest anaphylaxis. (b-s-h.org.uk)
Recommended Management by Severity
Mild allergic manifestations
- Mild allergic reactions may be managed by slowing the transfusion and giving an antihistamine. (b-s-h.org.uk)
- For mild reactions, transfusion may be continued with direct observation in appropriate clinical settings. (b-s-h.org.uk)
Severe allergic reaction / anaphylaxis
- Stop the transfusion and call for additional help because deterioration may occur quickly. (isbtweb.org)
- Maintain airway and give supplemental oxygen. (isbtweb.org)
- Administer intramuscular epinephrine (adrenaline) for anaphylaxis. (b-s-h.org.uk)
- Bronchodilators should be used for bronchospasm. (isbtweb.org)
- Anti-histamines and corticosteroids are probably of little use in the acute setting. (isbtweb.org)
Epinephrine (Adrenaline) Administration for Anaphylaxis
- Intramuscular epinephrine should be given in the anterolateral thigh (middle third). (resus.org.uk)
- Adult dose: 0.5 mg IM (500 micrograms) of 1 mg/mL (1:1000) epinephrine. (resus.org.uk)
- Repeat IM epinephrine after 5 minutes if there is no improvement in respiratory or cardiovascular status. (resus.org.uk)
Investigation and Reporting
- The implicated unit should be returned to the laboratory and the blood service contacted immediately for further evaluation. (b-s-h.org.uk)
- All transfusion reactions except mild febrile and/or mild allergic reactions should be reported to appropriate haemovigilance/regulatory organizations and reviewed locally. (b-s-h.org.uk)
Prevention of Recurrence
- In patients with recurrent allergic reactions, premedication with antihistamines prior to transfusion may be considered. (isbtweb.org)
- For severe and/or recurrent allergic reactions with worsening symptoms, washed cellular blood products may be considered to reduce exposure to donor plasma proteins. (isbtweb.org)
- Patients with anaphylaxis should receive future transfusions only in settings with direct observation and staff trained in managing anaphylaxis. (isbtweb.org)