A case of allergic reaction caused by platelet transfusion

Preface

Blood transfusion therapy is an indispensable part of clinical medicine, and many patients benefit from it, especially for patients with trauma, immune diseases, chronic diseases, etc.
It has an irreplaceable role
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Allergic transfusion reaction (ATRs) is one of the two most common adverse blood transfusion reactions.
It is an allergic reaction of varying severity caused by the blood components transfused.
There is one case of allergy caused by platelet transfusion in our hospital.
Reaction case
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Case history

A 70-year-old female patient complained of continuous aggravation of unwillingness to eat, nausea after eating, stomach swelling and discomfort, and general aches.
On September 28, she was admitted to the Spleen and Stomach Department of our hospital for "staleness"
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On the day of admission, hemoglobin was 53g/L, platelets were 62×10 ⁹ /L, and 2 U of white suspended red blood cells were applied for and transfused on the same day (matched blood, anti-screening negative), no adverse blood transfusion reactions; on September 29, hemoglobin rose to 68g/L , The platelet decreased to 42×10 ⁹ /L/

On October 1st, apply for and transfusion again to remove white suspended red blood cells 2U (matching blood, anti-screening negative), no adverse blood transfusion reaction; October 2nd hemoglobin increased to 78g/L, platelets decreased to 23×10 ⁹ /L

Because the patient’s platelets were low and continued to decline, he applied for and transfused one platelet for apheresis on October 5th.

case analysis

Pathogenesis of allergic transfusion reaction:

* Mild: The soluble sensitizer in the donor's plasma reacts with the IgE antibody in the recipient, and mast cells and basophils release histamine, causing urticaria

*Severe: The patient's IgA deficiency (or lack of a certain IgA subtype) is caused by the presence of IgA antibodies in the body

Allergic transfusion reaction is an allergic transfusion reaction caused by the transfusion of plasma or blood products containing plasma components.

Recommendations for retransfusion: on the basis of taking measures and treatment effects for common ATRs symptoms, drawing on the principle of compatible blood transfusion of the red blood cell blood group system, reacting to donor plasma, removing plasma when transfusing red blood cell products; reacting to donor red blood cells, It is advisable to transfuse washed red blood cells; patients with multiple blood transfusions should reduce the frequency of blood transfusions, which can reduce the chance of immunity; those with a history of allergies can consider early drug prevention

Summary

The two most common types of adverse blood transfusion reactions and their treatment

01

Febrile non-hemolytic transfusion reactions (52% of total adverse transfusion reactions)

Symptoms and signs:

Generally 15min-2h after blood transfusion;

Sudden fever, chills, chills, sweating, body temperature can reach 38-41℃;

Some patients are accompanied by nausea, vomiting, skin flushing, heart palpitations and headaches, and blood pressure is mostly unchanged; in general anesthesia, fever reactions rarely occur

Treatment measures:

Stop blood transfusion and keep intravenous infusion unobstructed

Pay attention to warmth, antipyretic, sedation, generally take aspirin or dexamethasone, etc.

Medical staff closely observe changes in the condition, and measure body temperature and blood pressure every 15-30 minutes; patients with severe fever will be given physical cooling

Stop blood transfusion and keep intravenous infusion unobstructed

Pay attention to warmth, antipyretic, sedation, generally take aspirin or dexamethasone, etc.

Medical staff closely observe changes in the condition, and measure body temperature and blood pressure every 15-30 minutes; patients with severe fever will be given physical cooling

Moderate and severe fever laboratory disposal process:

Standard tests (complete blood count, liver and kidney function test and urinary hemoglobin test, DAT direct antiglobulin test, Ig immunoglobulin, LDH lactate dehydrogenase)

Collect blood samples and repeat compatibility test, DAT, LDH and haptoglobin determination

Patient blood bacterial culture

Coagulation test

If the fever persists, return the blood to the laboratory and repeat serological tests (compatibility test, antibody screening and DAT), haptoglobin determination and bacterial culture

Standard tests (complete blood count, liver and kidney function test and urinary hemoglobin test, DAT direct antiglobulin test, Ig immunoglobulin, LDH lactate dehydrogenase)

Collect blood samples and repeat compatibility test, DAT, LDH and haptoglobin determination

Patient blood bacterial culture

Coagulation test

If the fever persists, return the blood to the laboratory and repeat serological tests (compatibility test, antibody screening and DAT), haptoglobin determination and bacterial culture

02

Allergic blood transfusion reaction (accounting for 45% of total adverse blood transfusion reactions)

Symptoms and signs:

It usually occurs within a few minutes after blood transfusion, but can also occur during or immediately after blood transfusion

Mild: general skin itching, skin erythema, urticaria, angioedema (more common on the face) and joint pain, blood eosinophilia

Severe: bronchospasm, laryngeal mucosal edema, dyspnea, asthma, cyanosis, or even anaphylactic shock

It usually occurs within a few minutes after blood transfusion, but can also occur during or immediately after blood transfusion

Mild: general skin itching, skin erythema, urticaria, angioedema (more common on the face) and joint pain, blood eosinophilia

Severe: bronchospasm, laryngeal mucosal edema, dyspnea, asthma, cyanosis, or even anaphylactic shock

Treatment measures:

Stop blood transfusion immediately and keep the venous passage unobstructed

For those with bronchospasm, 0.

In severe or persistent cases, intravenous or intravenous infusion of hydrocortisone, dexamethasone, aminophylline, etc.

When there is laryngeal edema, the trachea should be intubated immediately to avoid suffocation

People with anaphylactic shock should actively undergo anti-shock treatment

Stop blood transfusion immediately and keep the venous passage unobstructed

For those with bronchospasm, 0.

In severe or persistent cases, intravenous or intravenous infusion of hydrocortisone, dexamethasone, aminophylline, etc.

When there is laryngeal edema, the trachea should be intubated immediately to avoid suffocation

People with anaphylactic shock should actively undergo anti-shock treatment

Laboratory disposal process:

Mucosal edema (angioneurotic edema): standard examination, measuring IgA level, if it is less than 0.
07g/L and there is no hypogammaglobulinemia, a more sensitive confirmation test and IgA antibody detection are required

Difficulty breathing, wheezing or allergic reaction manifestations: standard examination, measuring blood oxygen saturation or blood gas, chest X-ray examination (if the symptoms are severe, must be checked), if a moderate or severe allergic reaction is suspected, determine the IgA level; if it is suspected of severe Allergic reactions, consider measuring mast cell trypsin (immediately 3h and 24h)

Hypotension (the simple reduction of systolic blood pressure is greater than or equal to 30mmHg, causing it to drop to less than or equal to 80mmHg): The test protocol is the same as that of fever.
If an allergic reaction is suspected, the IgA level is determined; if a severe allergic reaction is suspected, the mast cell trypsin is determined according to the above protocol series

Clinical medical staff should fully understand the risks associated with blood transfusion, strengthen the training of blood transfusion knowledge and skills, strictly grasp the indications of blood transfusion, and use blood scientifically and rationally.
Individualized blood transfusion programs should be adopted for different patients, and the blood transfusion treatment process should be rigorous.
Monitor all links to reduce the occurrence of adverse blood transfusion reactions in many ways to ensure the safety and effectiveness of blood transfusion treatment
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