Septic Transfusion Reactions
DIAGNOSIS: Quite honesly, as discussed in the section on the acute crash, the diagnosis of a classic Septic Reaction is not usually all that difficult.
The patient who has near-total cardiovascular collapse with a sky-high fever in the first 15 minutes or so after the onset of transfusion probably has bacterial contamination or acute hemolysis (more likely contamination if the reaction happens in the first few moments of transfusion). The gold standard for diagnosing contamination, the gram stain and culture of the unit, should be a part of the workup of every acutely crashing transfused patient. In addition, you may find hemoglobinemia in the patient (due to nonimmune hemolysis in the bag) or a "muddy" appearance to the remainder of the transfused blood (though you would hope that appearance would be noted before the blood actually left your Transfusion Service!).
I really must address several issues regarding of the use of gram stain and culture for diagnosis of these reactions. If you'll select each one in turn, I'll alert you to some potential pitfalls.
- Source of the sample
- Reliability of the gram stain
- Urgency of action
- Should all reactions with fever lead to culture?
After you've checked those out, (or if you're just bored), we'll move on to the pathophysiology of Septic Reactions.
Back to Septic Transfusion Reactions
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