Febrile and Allergic Transfusion Reactions

Harm, Sarah; Fung, Mark

doi:10.1002/9781119665885.ch9

Cited by 1 publication

(2 citation statements)

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“…99 This, and other important reactions that may be encountered by the anesthesiologist, such as hemolytic reactions, allergic reactions, and volume overload, are summarized in table 3. 98,[100][101][102][103][104] The anesthesiologist sends an arterial blood gas that returns a Pao 2 of 72 mmHg on a fractional inspired oxygen tension of 0.6. She makes a diagnosis of transfusion-related acute lung injury, and calls the transfusion medicine service to report the reaction.…”

Section: Transfusion Reactionsmentioning

confidence: 99%

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What’s in Your Transfusion? A Bedside Guide to Blood Products and Their Preparation

Hess

2023

Anesthesiology

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A general understanding of blood products and their modifications will help any physician make good decisions about transfusion. The separation of blood into products makes the fullest use of every donation: it maximizes the lifespan of each component, allows us to treat specific hematologic deficits, and offers the benefit of one donation to many patients. Every product is also modified in some way to prevent clotting, extend shelf life, improve efficacy, or reduce the risk of adverse events. Every one of these steps has been developed with patient benefit in mind, but they still have consequences that anesthesiologists have to be aware of. In some cases, these consequences have provoked complex responses: the development of Massive Transfusion Protocols and balanced "1:1:1" transfusions was essentially a scientific, clinical, and administrative effort to undo the inadvertent harms of separating whole blood into red cells, plasma, and platelets. With a limited blood supply and competing clinical requirements, understanding what you are actually transfusing is essential.In this narrative review, I will discuss the five basic blood products and five common modifications. Each product or modification is presented within a short clinical vignette; details are supplied in the figures and tables. I have also included a brief section on important transfusion reactions and their management. Finally, there is a list of additional resources for the interested reader. Blood ProductsOur blood supply in the United States comes from around 8 million donors who give between 1 and 20 times each year. 1 Although approximately 14 million products are collected every year, there are less than 2 weeks' supply of red cells and plasma in the U.S. inventory, and sometimes less than a day's supply of platelets. 2 Forty percent of the U.S. blood supply is collected by the American Red Cross (Washington, D.C.), with most of the rest collected by other independent institutions like Blood Bank of Hawaii (Honolulu, Hawaii) or OneBlood (St. Petersburg, Florida). 1,2 These blood centers are responsible for screening donors, collecting blood, separating them as necessary, labeling blood so it can be shipped in interstate commerce if the center is so licensed, and maintaining records (fig. 1). [3][4][5][6][7] Hospitals and clinics pay blood collectors for their products to cover the costs of materials, testing, and labor, with the specific price dependent on the unit and local contracts. There are also many for-profit blood centers that collect plasma and cells for the commercial preparations of albumin, immunoglobins, biologic therapies, and other reagents. Donors to commercial centers are usually paid to donate, but almost all blood collected for clinical transfusion in the United States comes from unpaid volunteers. 9 Low-titer Group O Whole BloodA 23-yr-old woman is hurt in a car crash. At the scene she has bilateral thigh deformities, tachycardia, hypotension, and altered consciousness. In the helicopter ride to the trauma center, she rece...

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