Allergic transfusion reaction

An allergic transfusion reaction is when a blood transfusion results in allergic reaction. It is among the most common transfusion reactions to occur. Reported rates depend on the degree of active surveillance versus passing reporting to the blood bank.[1][2] Overall, they are estimated to complicate up to 3% of all transfusions.[3] The incidence of allergic transfusion reactions is associated with the amount of plasma in the product.[3] More than 90% of these reactions occur during transfusion.

Cause

Allergic reactions from blood transfusion may occur from the presence of allergy-causing antigens within the donor's blood,[4] or transfusion of antibodies from a donor who has allergies, followed by antigen exposure.[5][6]

An allergic transfusion reaction is a type of transfusion reaction that is defined according to the Center for Disease Control (CDC) [7] as:

Diagnosis

An allergic transfusion reaction is diagnosed if two or more of the following occur within 4 hours of cessation of transfusion:[8]

  • Conjunctival edema
  • Edema of lips, tongue and uvula
  • Erythema and edema of the periorbital area
  • Generalized flushing
  • Hypotension
  • Localized angioedema
  • Maculopapular rash
  • Pruritus (itching)
  • Respiratory distress; bronchospasm
  • Urticaria (hives)

A probable diagnosis results if any one of the following occurring within 4 hours of cessation of transfusion:

  • Conjunctival edema
  • Edema of lips, tongue and uvula
  • Erythema and edema of periorbital area
  • Localized angioedema
  • Maculopapular rash
  • Pruritus (itching)
  • Urticaria (hives)

The UK hemovigilance reporting system (SHOT), has classified allergic reactions in to mild, moderate and severe.[9] Reactions can occur that have features of both allergic and febrile reactions.[9]

Mild

A rash, urticaria, or flushing[9]

Moderate

Wheeze (bronchospasm) or angioedema but blood pressure normal and no respiratory compromise. There may or may not be an associated rash or urticaria.[9]

Severe

This can be due to:

Prevention

To prevent allergic transfusion reaction it is possible to use patients own blood for transfusion, this is referred to as autologous blood transfusion. Patients’ own blood is collected and washed to produce concentrated red blood cells (this blood product is also called packed red blood cells). There are multiple ways to wash red blood cells. The two main methods that are used to wash the cells are centrifugation, or filtration methods like the Hemoclear microfilter. The last option is reinfusion without washing. This is the least preferred method because of the chance of complications.[10]

There is no evidence that antihistamine premedication prevents allergic transfusion reactions, although these drugs can mitigate symptoms once they occur.[11][12][3]

Treatment

Treatment of an allergic transfusion reaction is to immediately stop the transfusion. If the only symptoms are mild (i.e., hives and itching), the patient may be treated with an antihistamine and if the symptoms completely disappear and the patient feels well, the transfusion may be restarted. A mild transfusion reaction during infusion usually does not progress to a more severe anaphlyactic reaction after infusion of additional product from the same unit.[3] If the symptoms are more than mild, the transfusion should not be restarted.

References
  1. Savage WJ, Tobian AA, Savage JH, Wood RA, Schroeder JT, Ness PM (June 2013). "Scratching the surface of allergic transfusion reactions". Transfusion. 53 (6): 1361–71. doi:10.1111/j.1537-2995.2012.03892.x. PMC 3711222. PMID 22998777.
  2. Hirayama, Fumiya (February 2013). "Current understanding of allergic transfusion reactions: incidence, pathogenesis, laboratory tests, prevention and treatment". British Journal of Haematology. 160 (4): 434–444. doi:10.1111/bjh.12150. PMC 3594969. PMID 23215650.
  3. Savage WJ (June 2016). "Transfusion Reactions". Hematology/Oncology Clinics of North America. 30 (3): 619–34. doi:10.1016/j.hoc.2016.01.012. PMID 27113000.
  4. Jacobs, Joannes F.M.; Baumert, Joseph L.; Brons, Paul P.; Joosten, Irma; Koppelman, Stef J.; van Pampus, Elisabeth C.M. (19 May 2011). "Anaphylaxis from Passive Transfer of Peanut Allergen in a Blood Product". New England Journal of Medicine. 364 (20): 1981–1982. doi:10.1056/NEJMc1101692. PMID 21591965.
  5. Ching, Joyce Cheung Yee; Lau, Wendy; Hannach, Barbara; Upton, Julia Elizabeth Mainwaring (8 September 2015). "Peanut and fish allergy due to platelet transfusion in a child". Canadian Medical Association Journal. 187 (12): 905–907. doi:10.1503/cmaj.141407. PMC 4562830. PMID 25852036.
  6. Dina Fine, Maron. "When Peanut Allergy Comes from a Blood Transfusion". Scientific American. Retrieved 15 December 2018.
  7. "CDC NHSN Biovigilance Component: Hemovigilance Module Surveillance Protocol v2.5.2". 2019-11-25.
  8. "Proposed standard definitions for surveillance of non infectious adverse transfusion reactions" (PDF). www.isbtweb.org. Retrieved 2019-01-09.
  9. Bolton-Maggs, PHB, ed. (2018). The 2017 Annual SHOT Report (PDF). SHOT.
  10. Liumbruno, Giancarlo Maria; Waters, Jonathan H. (July 2011). "Unwashed shed blood: should we transfuse it?". Blood Transfusion. 9 (3): 241–245. doi:10.2450/2011.0109-10. ISSN 1723-2007. PMC 3136589. PMID 21627923.
  11. Wang SE, Lara PN, Lee-Ow A, Reed J, Wang LR, Palmer P, Tuscano JM, Richman CM, Beckett L, Wun T (July 2002). "Acetaminophen and diphenhydramine as premedication for platelet transfusions: a prospective randomized double-blind placebo-controlled trial". American Journal of Hematology. 70 (3): 191–4. doi:10.1002/ajh.10119. PMID 12111764.
  12. Kennedy LD, Case LD, Hurd DD, Cruz JM, Pomper GJ (November 2008). "A prospective, randomized, double-blind controlled trial of acetaminophen and diphenhydramine pretransfusion medication versus placebo for the prevention of transfusion reactions". Transfusion. 48 (11): 2285–91. doi:10.1111/j.1537-2995.2008.01858.x. PMID 18673350.
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