What symptoms should be monitored in a patient undergoing platelet apheresis?

Symptoms to Monitor During Platelet Apheresis Transfusion

Monitor for transfusion reactions including fever, chills, respiratory distress, hypotension, allergic symptoms (urticaria, bronchospasm), and signs of transfusion-related acute lung injury (TRALI) or circulatory overload (TACO), with vital signs checked pre-transfusion, at 15 minutes, at completion, and 15 minutes post-transfusion. 1

Critical Monitoring Parameters and Timing

Vital signs must be monitored at specific intervals:

• Pre-transfusion baseline 1
• 15 minutes after starting transfusion 1
• At completion of transfusion 1
• 15 minutes post-transfusion 1

The first 10 minutes are the highest risk period—immediate reactions typically occur within the first minute of infusion. 1

Monitor these specific parameters:

• Heart rate (tachycardia >110 beats/min requires immediate action) 1
• Blood pressure (systolic <80 mmHg or hypertension) 1
• Temperature (fever or chills) 1
• Respiratory rate and oxygen saturation 1

Life-Threatening Reactions Requiring Immediate Recognition

Transfusion-Related Acute Lung Injury (TRALI)

TRALI presents with the hallmark triad of hypoxemia, dyspnea, and hypotension within 1-2 hours after transfusion. 2 Apheresis platelets are among the blood products most frequently implicated in TRALI due to their significant plasma content that may harbor leukocyte antibodies. 1

Key distinguishing features:

• Hypotension (not hypertension) is the critical diagnostic feature 2
• Non-cardiogenic pulmonary edema 2
• Severe hypoxemia requiring 100% oxygen 2
• Fluid in endotracheal tube if intubated 1

Critical pitfall: Do not administer diuretics—TRALI requires supportive care with oxygen therapy and critical care measures, not volume removal. 2

Transfusion-Associated Circulatory Overload (TACO)

TACO is now the most common cause of transfusion-related mortality, occurring during or up to 12 hours after transfusion. 1

Distinguishing features from TRALI:

• Hypertension (not hypotension) 2
• Cardiovascular changes suggesting fluid overload 1
• Pulmonary edema with evidence of volume overload 1
• Tachycardia 1

Anaphylaxis and Severe Allergic Reactions

Wheezing during transfusion suggests anaphylaxis or severe allergic reaction requiring urgent intervention. 3

Monitor for:

• Bronchospasm and wheezing 3
• Hypotension and tachycardia 3
• Urticaria and pruritus 3
• Potential cardiovascular collapse 3

Immediate action: Administer epinephrine 50 mcg IV (0.5 mL of 1:10,000 solution) for adults if wheezing occurs with any signs of systemic reaction. 3

Common Adverse Events Specific to Platelet Apheresis

Citrate-Related Reactions

Citrate toxicity is one of the most common adverse events, occurring in 0.96-1.2% of plateletpheresis procedures. 4, 5

Symptoms to monitor:

• Paresthesias (tingling around mouth, fingers) 4
• Nausea and vomiting 4
• Tetany or seizures (rare, 0.2%) 4
• Muscle cramping 5

Vasovagal and Hemodynamic Events

Vasovagal reactions occur in approximately 0.5% of procedures. 4

Monitor for:

• Pallor and diaphoresis 4
• Nausea and vomiting 4
• Hypotension (systolic BP <80 mmHg occurs in 1.0% of procedures) 4
• Presyncopal or syncopal episodes (0.096-1.17%) 5

Transfusion Reactions from Plasma Component

Transfusion reactions occur in 1.6% of procedures, particularly with plasma exchange procedures. 4

Monitor for:

• Fever and chills 6
• Respiratory distress (0.3% incidence) 4
• Hemolytic reactions (check urine output and color) 3

Bacterial Contamination

Transfusion-associated bacteremia should be suspected if patients experience severe febrile reactions during or shortly after platelet transfusions. 6

Monitor for:

• Severe fever during or shortly after transfusion 6
• Rigors or chills (0.2% incidence) 4
• Hypotension 6

Action required: Discontinue transfusion, obtain cultures from platelet bag and patient blood, and strongly consider antibiotic treatment, particularly in neutropenic recipients. 6

Storage-Related Complications

Prolonged storage of apheresis/irradiated platelets is associated with higher frequency of inflammatory adverse events. 7

Inflammation-type adverse events increase with platelet age, with an odds ratio of 1.30 per day of storage. 7 Apheresis/irradiated platelets cause significantly more adverse events (57.2/10,000) compared to whole blood-derived/non-irradiated platelets (26.0/10,000). 7

Immediate Action Algorithm When Symptoms Occur

Stop the transfusion immediately at the first sign of any suspected reaction—this is the single most critical intervention. 1

Maintain IV access with normal saline for medication administration and fluid resuscitation. 1

Call for help and note the time of reaction onset. 3

Assess airway, breathing, and circulation using a team-based approach. 3

Administer 100% oxygen to address potential hypoxemia. 1

Monitor vital signs every 5-15 minutes. 1

Notify the transfusion laboratory immediately to report the reaction and initiate investigation. 1

Send post-reaction blood samples: complete blood count, direct antiglobulin test, repeat crossmatch, PT, aPTT, fibrinogen, and visual inspection of plasma for hemolysis. 1

Special Monitoring Considerations

Continue observation for at least 24 hours for severe reactions, as delayed complications may occur. 3 TRALI can evolve over the first 6-12 hours post-transfusion. 2

Document all transfusions in patient record—100% traceability is a legal requirement. 1

Do not restart the transfusion even if symptoms improve, as the reaction may worsen with continued exposure. 3