Transfusion Practices: Component Therapy, Modifications, Administration, and Adverse Events
Core concepts
Component modification matches patient need: irradiated components (25–30 Gy) prevent transfusion-associated graft-versus-host disease in immunocompromised or HLA-matched recipients; washed red cells reduce IgA and plasma proteins for anaphylactic reactions; leukoreduced products reduce febrile nonhemolytic reactions and CMV risk; volume-reduced or fresh components for neonates.
Administration: verify patient identity and unit at bedside, use a 170–260 µm filter, complete within 4 hours, and monitor vital signs before, 15 minutes after start, and at completion. Do not add medications to the line; use 0.9% saline if needed.
Adverse events: acute hemolytic (ABO error, fever, back pain, DIC, hemoglobinuria), febrile nonhemolytic (cytokines/leukocytes), allergic/anaphylactic (IgA deficiency), TRALI (within 6 h, bilateral infiltrates), TACO (volume overload), delayed hemolytic (3–14 days, antibody anamnestic), septic (bacterial contamination, platelets most common), and TA-GVHD (rash, pancytopenia, 1–6 weeks).
Traps
Differentiate TRALI from TACO: TRALI is noncardiogenic, often with fever and hypotension; TACO responds to diuretics. Acute hemolytic reaction is a clerical error until proven otherwise-stop the transfusion immediately.
Worked example
Fever and dark urine 10 minutes into a red cell transfusion, with a positive DAT and hemoglobinemia: stop transfusion, maintain urine output, notify blood bank, and investigate clerical error and ABO mismatch.