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Blood transfusion reactions and transplant rejection: Pathology Review

Osmosis from Elsevier・16 minutes read

Adam likely experienced a blood transfusion reaction, presenting with symptoms like shortness of breath, vomiting, rash, and low blood pressure, while Jack appears to be undergoing transplant rejection post-kidney transplantation, characterized by fever, malaise, and high blood pressure. Various types of blood transfusion reactions, including anaphylactic, acute hemolytic, delayed hemolytic, febrile non-hemolytic, transfusion-related acute lung injury, and transfusion-associated circulatory overload, are important to recognize due to distinct presentations and potential severity.

Insights

  • Adam's symptoms indicate a blood transfusion reaction, while Jack is likely experiencing transplant rejection, showcasing the diverse complications that can arise post-medical procedures.
  • Understanding the six types of blood transfusion reactions, from anaphylactic to febrile non-hemolytic, is crucial for prompt identification and appropriate management, highlighting the complexity and potential severity of adverse transfusion events.

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Recent questions

  • What are the symptoms of an anaphylactic transfusion reaction?

    An anaphylactic transfusion reaction is a type 1 hypersensitivity reaction mediated by the recipient's IgE antibodies against plasma proteins. Symptoms include urticaria, fever, wheezing, hypotension, and anaphylactic shock.

  • How does acute hemolytic transfusion reaction occur?

    Acute hemolytic transfusion reaction, a type 2 hypersensitivity reaction, happens due to blood type incompatibility, leading to intravascular hemolysis. Symptoms include fever, hypotension, and jaundice.

  • What is the typical presentation of delayed hemolytic transfusion reaction?

    Delayed hemolytic transfusion reaction usually occurs within one to two weeks post-transfusion due to antibodies against minor antigens. It results in extravascular hemolysis with mild symptoms like fever and jaundice.

  • What is transfusion-related acute lung injury (TRALI)?

    Transfusion-related acute lung injury (TRALI) is a severe reaction causing non-cardiogenic pulmonary edema. It is characterized by respiratory distress, fever, and hypotension, with treatment involving respiratory support.

  • How can graft versus host disease be prevented?

    Prevention of graft versus host disease involves irradiating blood products to eliminate lymphocytes before transfusion. However, it can be intentionally induced in leukemia patients for a graft versus tumor effect.

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Summary

00:00

Blood Transfusion and Transplant Reactions Explained

  • Adam, a 35-year-old, arrives at the emergency department after a motor vehicle crash, presenting with significant bleeding from his thigh.
  • A blood transfusion is administered to Adam, who subsequently develops shortness of breath, non-bloody vomiting, and a diffuse rash with erythematous borders all over his body, along with a drop in blood pressure to 60 over 40 millimeters of mercury.
  • Jack, a 50-year-old, complains of fever, malaise, and decreased urine production for two days following a kidney transplantation a month ago, with high blood pressure of 150 over 80 millimeters of mercury.
  • Adam's symptoms suggest a blood transfusion reaction, while Jack appears to be experiencing transplant rejection, where the recipient's immune system attacks the transplanted organ.
  • Six types of blood transfusion reactions are crucial to recognize, including anaphylactic or allergic, acute hemolytic, delayed hemolytic, febrile non-hemolytic, transfusion-related acute lung injury, and transfusion-associated circulatory overload.
  • Anaphylactic transfusion reaction is a type 1 hypersensitivity reaction mediated by the recipient's IgE antibodies against plasma proteins, leading to symptoms like urticaria, fever, wheezing, hypotension, and anaphylactic shock.
  • Acute hemolytic transfusion reaction, a type 2 hypersensitivity reaction, occurs due to blood type incompatibility, resulting in intravascular hemolysis and symptoms like fever, hypotension, and jaundice.
  • Delayed hemolytic transfusion reaction typically arises within one to two weeks post-transfusion due to antibodies against minor antigens, leading to extravascular hemolysis with mild symptoms like fever and jaundice.
  • Fibrile non-hemolytic transfusion reaction, common in children, manifests as fever post-transfusion due to inflammatory mediators' release, potentially involving a type 2 hypersensitivity reaction targeting human leukocyte antigens.
  • Transfusion-related acute lung injury (TRALI) is a severe reaction causing non-cardiogenic pulmonary edema, characterized by respiratory distress, fever, and hypotension, with treatment involving respiratory support.
  • Transplant rejection includes hyperacute, acute, and chronic types, with hyperacute rejection occurring within minutes due to pre-formed antibodies attacking the graft, necessitating prompt graft removal.

18:34

Graft versus host disease and transfusion reactions

  • Graft versus host disease can present with a maculopapular rash, hepatosplenomegaly, jaundice, and diarrhea, while chronic cases may affect the lungs causing dyspnea and muscles leading to cramps and weakness.
  • Prevention of graft versus host disease involves irradiating blood products to eliminate lymphocytes before transfusion, although it can be intentionally induced in leukemia patients for a graft versus tumor effect.
  • Transfusion reactions include anaphylactic reactions mediated by recipient IgE, acute hemolytic reactions due to incompatibility, delayed hemolytic reactions from newly formed antibodies, and febrile non-hemolytic reactions caused by cytokine release from white blood cells in donor blood. Other reactions like transfusion-related acute lung injury and circulatory overload have distinct presentations and timeframes.
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