Pediatric emergency medicine trisk 564

TABLE 93.13 SYSTEMIC HEPARIN ADMINISTRATION AND ADJUSTMENT TABLE 93.14 TRANSFUSION REACTIONS TRANSFUSION REACTIONS Clinical Recognition Reactions to transfused blood products may be acute (during or within 24 hours of transfusion) or delayed (days to weeks posttransfusion) The most feared, but fortunately now uncommon transfusion reaction, is an acute hemolytic transfusion reaction This type of reaction occurs due to the presence of a complement-fixing RBC antibody that causes rapid and often severe intravascular hemolysis The patient will have a newly positive DAT (Coombs) The uncommon occurrence of this problem is, in large part, a tribute to careful blood banking practices and close attention to the administration of the properly identified RBC product to the correct recipient thereby avoiding infusion of ABO-incompatible red cells The release of proinflammatory cytokines as a result of complement activation gives rise to the characteristic symptoms of apprehension, fever, chills, abdominal or flank pain, chest tightness, and hypotension as well as activation of the coagulation cascade potentially manifesting as DIC Other potentially lifethreatening transfusion reactions include transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), anaphylactic transfusion reaction, and septic transfusion reaction ( Table 93.14 ) TRALI is defined as acute lung injury with hypoxemia (PaO2 /FiO2 ≤300 or room air O2 saturation