Title: Understanding and Preventing Blood Transfusion Reactions: A Comprehensive Guide
Overview: Blood transfusion, a vital treatment modality, is widely employed in various clinical settings to improve patient outcomes and reduce mortality. However, it is not without its risks, including the potential for adverse reactions. This article delves into the types, diagnosis, treatment, and prevention of blood transfusion reactions, aiming to provide a comprehensive guide for healthcare professionals and patients alike.
The Types of Blood Transfusion Reactions: Blood transfusion reactions are categorized into two main types: hemolytic reactions and non-hemolytic reactions.
Hemolytic Reactions are further divided into acute and chronic. Acute hemolytic reactions occur minutes to hours after transfusion, presenting with symptoms like back pain, headache, chest tightness, fever, chills, tachycardia, dyspnea, nausea, pallor, profuse sweating, cold skin, anxiety, hemoglobinuria, acute renal failure, and DIC. Chronic hemolytic reactions, also known as delayed hemolytic transfusion reactions, often manifest with jaundice and elevated reticulocytes 3-7 days post-transfusion.
Non-hemolytic Reactions include fever reactions (with symptoms such as chills, fever, nausea, vomiting, and skin flushing), allergic reactions (ranging from urticaria and angioedema to anaphylaxis), and infectious diseases transmitted via blood (like viral hepatitis, AIDS, cytomegalovirus infection, syphilis, malaria, and other infectious agents).
Diagnosis: Diagnosis is based on clinical symptoms and signs, as well as various laboratory tests, including blood and urine routine tests, hematopoietic cell quality analysis, reticulocyte count, coagulation function tests, acid haemolysis test, urine hemosiderin test, cold agglutinin test, red cell fragility test, autoantibody test, bilirubin, platelet-associated antibody, fibrinogen quantification, platelet membrane GP II b/III a, liver and kidney function tests, electrolytes, blood gas analysis, bone marrow cytology, bone marrow imprinting, bone marrow smears, bone marrow Coombs test, bone marrow iron staining, bone marrow biopsy, pathogenic microorganisms, ultrasound, and skin biopsy.
Treatment: Management of blood transfusion reactions varies depending on the type and severity:
Acute Hemolytic Reaction: Immediate cessation of transfusion, high-dose corticosteroids, alkalinization of urine, diuresis, maintaining blood volume and electrolyte balance, correcting hypotension, preventing renal failure and DIC, and possibly dialysis, plasma exchange, or exchange transfusion.
Fever Reaction: Temporary cessation of transfusion, diagnosis, and symptomatic treatment such as warming, antipyretics, and antihistamines.
Allergic Reaction: Use of antihistamines for urticaria, adrenaline for bronchospasm, and corticosteroids for severe reactions or persistent symptoms.
Infectious Disease Transmission: Immediate cessation of transfusion, administration of broad-spectrum antibiotics, and supportive treatment.
DIC: Treatment with heparin.
Prevention: Prevention of blood transfusion reactions involves:
Strict adherence to the "Blood Donation Law of the People's Republic of China" and the "Clinical Blood Use Management Measures" (Clinical Blood Transfusion Technical Specifications).
Strengthening blood storage and transportation protocols to prevent acute hemolytic reactions.
Checking for blood type antibodies in patients who have received multiple transfusions or are pregnant to prevent chronic hemolytic reactions.
Avoiding plasma in patients with a history of transfusion allergies, opting instead for washed or frozen red blood cells.
Performing serological tests and selecting appropriate blood products to prevent allergic reactions.
Implementing measures to reduce the risk of infectious disease transmission, such as leukocyte reduction and the use of high-efficiency leukocyte filters.
In conclusion, while blood transfusions are a life-saving treatment, healthcare providers must be vigilant in diagnosing, managing, and preventing blood transfusion reactions to ensure patient safety and optimal outcomes.