| Problem |
Typical features |
Diagnostic tests |
| 1. |
Incorrect Blood or component transfused |
| |
ABO incompatible |
May be none – or major collapse
as for 2 |
Check identity and group of patient and unit [inc. RH(D)].May have +ve DAT. |
| ABO compatible |
May be none. As for 2 if
patient has atypical red cell
alloantibodies. |
Check identity and group of patient and unit [inc. RH(D)].
May have +ve DAT. |
| 2. |
Acute Transfusion Reaction |
| |
Acute haemolytic
transfusion reaction |
Dyspnoea, chest pain, fever, chills,
↓BP, ↓urine output, DIC |
Haemoglobinaemia/uria, ↓Hb, +ve DAT, serological
incompatibility, spherocytes on blood film. |
| Anaphylaxis |
↓BP, dyspnoea, +/-
bronchospasm, +/- rash. |
Occasionally patient has severe IgA deficiency. |
3.
|
Delayed haemolytic
transfusion reaction |
Unexplained fall in Hb. Jaundice,
dark urine. |
Urobilinogen in urine, ↑serum bilirubin, +ve DAT,
spherocytes, +ve antibody screen. |
4.
|
Transfusion-associated graft-versus-host disease (TA-GVHD) |
Progression of fever, rash, ↑liver
enzymes, diarrhoea, pancytopenia
(1-6 weeks post transfusion) |
Skin biopsy + cytogeneric or HLA analysis. DNA analysis
(eg RFLP, minisatellite probes) to establish presence of
third party lymphocytes. |
5. |
Transfusion-related acute lung injury (TRALI) |
Acute respiratory distress (non cardiogenic) Hypoxia, bilateral pulmonary infiltrates. |
This reaction must be reported urgently to Australian Red Cross Blood Service. Call 9694 0200 24 hours a day. |
6. |
Post-transfusion purpura |
Immune-mediated thrombocytopenia arising 5-12 days post-transfusion. |
HPA type patient. HPA antibodies (usually HPA-1a negative with anti-HPA-1a) |
7. |
Reaction to a bacterially contaminated component |
Rapid onset of circulatory collapse, fever |
This reaction must be reported urgently to Australian Red Cross Blood Service. Call 9694 0200 24 hours a day. |
8. |
Post transfusion viral infection |
Depends on virus. Eg. Jaundice,malaise, rash. Weeks to months post transfusion. |
This reaction must be reported urgently to Australian Red Cross Blood Service. Call 9694 0200 24 hours a day. |
| Near miss incidents |
9. |
Wrong blood in tube (WBIT) |
This is a near-miss category of incident where the error is picked up before the product is given
to the patient. It means that (a) the samples are taken from wrong patient but labelled as
per intended patient or (b) sample taken from intended patient but labelled as per another
patient or (c) mismatch between paperwork and specimen. |
10. |
Other near-miss |
Examples include: (a) Request errors such as wrong component requested, special requirements incorrectly specified or product requested for wrong patient, (b) Laboratory sample handling or testing errors (c) laboratory component selection, handling or storage errors, (d) component issue, transportation, collection or administration errors. |
