Source / episode info

• **Episode:**208
• **Title:**Divine Intervention Episode 208 – Transfusion Reactions.
• **Published:**2020-02-06
• Source:Episode page

One-liner

Episode 208 details six major transfusion reactions: AHTR (Type II, ABO error), Delayed Hemolysis (non-ABO antigens), Allergic (Type I, IgE crosslinking), FNHTR (cytokine release/Type III), TRALI (Anti-HLA complex deposition in lungs), TACO (fluid overload/cardiogenic edema), and TAGVHD (T-cell mediated attack).

High-yield summary

• Acute Hemolytic Transfusion Reaction (AHTR): Most common cause is ABO incompatibility (clerical error). Presents during transfusion with hematuria, flank pain. Mechanism: Type II hypersensitivity (preformed antibodies). Diagnosis: Direct Coombs Test positive.
• Allergic Reaction: Type I hypersensitivity. Triggered by transfused blood containing antigens to which the recipient has IgE antibodies. Presentation is predominantly airway/bronchospasm. Treatment requires immediate epinephrine.
• Febrile Non-Hemolytic Transfusion Reaction (FNHTR): Can be due to cytokine release from stored platelets/WBCs (easy mechanism) or Type III hypersensitivity (recipient Ab attacking donor WBCs, hard mechanism). Management: Antipyretics.
• TRALI: Non-cardiogenic pulmonary edema. Mechanism: Donor anti-HLA antibodies react with recipient leukocytes -> immune complex deposition in the lungs. Labs: PCWP < 18 mmHg. Treatment: Supportive care; avoid diuretics.
• TACO: Cardiogenic pulmonary edema due to fluid overload from large volume transfusion. Mechanism: Heart failure exacerbation. Labs: PCWP > 18 mmHg, elevated CVP/BNP. Management: Diuretics (e.g., furosemide).
• TAGVHD: T-cell mediated attack by donor T cells against recipient tissues. Risk factor: Immunocompromised recipient (e.g., post-BMT). Prevention: Gamma globulin administration or blood irradiation.

Learning objectives

• Differentiate between Type I, II, and III hypersensitivity reactions in the context of blood transfusion.
• Recognize the classic clinical presentation and underlying pathophysiology of AHTR vs. Delayed Hemolysis.
• Distinguish the pulmonary edema patterns (cardiogenic TACO vs. non-cardiogenic TRALI) using hemodynamic parameters (PCWP).
• Understand the mechanism and prevention strategies for T-cell mediated graft versus host disease (TAGVHD).
• Initiate appropriate supportive care, including fluid management and anti-inflammatory agents, based on the specific transfusion reaction.