Exploring patient participation in reducing health-care-related safety risks

Exploring patient participation in reducing health-care-related safety risks
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Box A3 .2 . Categories of reactions
Categories of reactions
FNHTR
Increase of body temperature of >=2°C (with or without rigors) during or in the first two hours after a blood
transfusion, if no other cause for the fever can be found and haemolysis has been excluded. Exclusion of
bacteriological or blood group serological causes and TRALI.
Acute haemolytic transfusion reaction
Signs starting within minutes or up to 24 hours after commencing transfusion, due to (usually complementmediated
intravascular) destruction of red blood cells. Most often caused by transfusion of AB0-incompatible
blood components, sometimes by irregular erythrocyte antibodies or occasionally by transfusion of a haemolytic
red blood cell concentrate or infusion of hypotonic fluids.
Delayed haemolytic transfusion reaction
Immune-mediated destruction of red blood cells occurring >24 hours after, and as a result of, transfusion of a
blood component.
TRALI
Clinical picture of adult respiratory distress syndrome: dyspnoea, hypoxia and a finely mottled appearance on
chest X-ray with onset up to six hours after administration of a (plasma-containing) blood component, if other
causes, such as anaphylaxis, infection and circulatory overload, have been excluded.
Circulatory overload
Onset within a few hours of transfusion of dyspnoea, orthopnoea, cyanosis, oedema of dependent parts, raised
central venous pressure, with congestive picture on chest X-ray.
Anaphylactic reaction
Serious allergic reaction with onset within seconds to minutes of commencing transfusion, with signs such as
airway obstruction, circulatory collapse or gastrointestinal signs as well as minor allergic manifestations.
Other allergic reactions
Within minutes to hours of starting transfusion, occurrence of allergic signs such as itching, erythema and
urticaria, without serious allergic manifestations.
Post-transfusion purpura
Severe temporary thrombocytopenia arising roughly 9 (1–24) days after a transfusion of red blood cells and/or
platelets, usually in a patient who has previously had a blood transfusion or been pregnant.
Bacterial contamination
Bacterial septicaemia that can be traced to a transfused blood component. May be difficult to distinguish from
a haemolytic transfusion reaction. Confirm diagnosis by bacteriological culture on the patient and the blood
component and/or another blood component resulting from the same donation.
Viral infection
Any viral infection that can be traced to a transfused blood component (hepatitis A, HBV, HCV, non-ABC,
HIV, human T-cell lymphotropic virus, Epstein-Barr virus, cytomegalovirus etc.)
Post-transfusion hepatitis
Significant rise in transaminases between 14 and 180 days after transfusion or a serologically confirmed new
infection with HBV or HCV in a patient who has been transfused. Transfusion-associated cytomegalovirus
infection A (probably) – primary cytomegalovirus infection in a recipient of a blood component should be
reported.
Transfusion-associated graft-versus-host disease reaction
Reaction 1–6 weeks (usually 8–10 days) after a T-cell blood component is administered, with (initially central)
erythema, watery diarrhoea, elevated liver enzymes and pancytopenia – generally involving a high risk of
mortality and caused by an immunological reaction of the donor’s T lymphocytes to the tissues of the recipient
(who had suppressed immunity).