Anaphylactic reaction blood transfusion

Aprotinin. Aprotinin is a naturally occurring serine protease inhibitor, has found widespread applications either by the intravenous route or as a component of biological sealants, because of its ability to decrease blood loss, and, as a consequence, transfusion requirements. Anaphylactic reactions are mediated by IgG and IgE antibodies. The risk of anaphylactic reactions has been estimated between 0.5 and 5.8% when used intravenously during cardiac surgery, and at 5 for 100,000 applications when used as a biologic sealant [25]. Patients previously treated with this drug present an increased risk and any new administration should be avoided for at least 6 months following an initial exposure [25]. 

Most anaphylactoid reactions are due to a direct or chemical release of histamine, and other mediators, from mast cells and basophils. Immune-mediated hypersensitivity reactions have been classified as types I-IV. Type I, involving IgE or IgG antibodies, is the main mechanism involved in most anaphylactic or immediate hypersensitivity reactions to anaesthetic drugs. Type II, also known as antibody-dependent hypersensitivity or cytotoxic reactions are, for example, responsible for ABO-incompatible blood transfusion reactions. Type III, immune complex reactions, include classic serum sickness. Type IV, cellular responses mediated by sensitised lymphocytes, may account for as much as 80% of allergic reactions to local anaesthetic. 

The client s assessment data indicates an anaphylactic reaction to the blood transfusion, which is life threatening. The nurse should take action and not assess the client. 

Since parathyroid hormone is not used in routine therapy, but in the diagnosis of hyperparathyroidism, its potential for immunogenicity is limited. Nevertheless, O Rolhrke et al. (1973) reported that intravenous injection of parathyroid hormone elicited an anaphylactic-type reaction in a patient. The patient had never received this hormone and had no history of atopy, but had received multiple blood transfusions in the past. Diagnostic tests (Sect. A.Ill) confirmed the presence of IgE antibodies, which were presumed responsible for the reaction. 

Immunologic Allergic reactions, such as anaphylaxis and transfusion reactions, are potential adverse reactions to prothrombin complex concentrates [32 ]. Patients with IgA deficiency and anti-IgA antibodies can have anaphylactic reactions after exposure to IgA-containing blood products, including prothrombin complex concentrates [71 ]. 

Adverse events related to transfusion of blood components have been reported, including febrile non-hemolytic transfusion reactions, mild febrile reactions, acute and delayed hemolytic transfusion reactions, transfusion-related acute lung injury (TRALl), anaphylactic and other allergic reactions, graft-versus-host disease (GvHD), transfusion-associated circulatory overload (TACO), viral infections, post-transfusion bacteremia, transfusion-associated sepsis (TAS), hemosiderosis, post-transfusion purpura, and new allo-antibody formation [18 , 19 ]. Whole blood, erythrocytes, leukocytes, platelets, and plasma for transfusion (fresh frozen plasma, FFP) are involved. Quite a number of these adverse effects, such as TRALl, TACO, TAS, and allergic/anaphylactic reactions can be difficult to evaluate. 

The transfusion of blood and blood products carries many risks, some of which are very serious. Haemolytic reactions caused by red cell antibodies, non-haemolytic febrile reactions due to white cell antibodies, urticaria, rare but extremely severe anaphylactic reactions caused by anti-IgA in patients lacking IgA, changes of pH and electrolytes resulting from storage lesions in stored bank blood, bacterial contamination, transmission of disease (in particular hepatitis, cytomegalic inclusion disease, mononucleosis infec-tiosa, syphilis, toxoplasmosis and malaria), circulatory overload and several other complications have been discussed in SED VIII and in many recent review articles. Infection with the virus of cytomegalic inclusion disease (CMV) occurs frequently. In most people it is a benign disease. Like other viral diseases, however, it should be feared in patients with an impaired cellular immunity (1, 2CR). 

Renal toxicity is the major potential toxicity of cisplatin. Severe nausea and vomiting that often accompany cisplatin administration may necessitate hospitalization. Cisplatin has mild bone marrow toxicity, yielding both leukopenia and thrombocytopenia. Anemia is common and may require transfusions of red blood cells. Anaphylactic allergic reactions have been described. Hearing loss in the high frequencies (4000 Hz) may occur in 10 to 30% of patients. Other reported tox-icities include peripheral neuropathies with paresthesias, leg weakness, and tremors. Excessive urinary excretion of magnesium also may occur. 

Leikola J, Koistinen J, Lehtinen M, Virolainen M (1973) IgA-induced anaphylactic transfusion reactions a report of four cases. Blood 42 111-119 LeVeen HH, Harry H, Giordano P, Speltzer J (1961) The mechanism of removal of intravenously injected fat. Arch Surg 83 311-321... 

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