Clinical Practice guidelines

𝗕𝗹𝗼𝗼𝗱 𝗧𝗿𝗮𝗻𝘀𝗳𝘂𝘀𝗶𝗼𝗻 𝗥𝗲𝗮𝗰𝘁𝗶𝗼𝗻𝘀
𝟭. 𝗔𝗰𝘂𝘁𝗲 𝗛𝗲𝗺𝗼𝗹𝘆𝘁𝗶𝗰 𝗧𝗿𝗮𝗻𝘀𝗳𝘂𝘀𝗶𝗼𝗻 𝗥𝗲𝗮𝗰𝘁𝗶𝗼𝗻 (𝗔𝗛𝗧𝗥)
Onset: Within minutes–1 hour
Cause:ABO incompatibility (usually clerical error) Preformed IgM → complement → intravascular hemolysis
𝗙𝗲𝗮𝘁𝘂𝗿𝗲𝘀:
Fever, chills
Flank/back pain (classic)
Hypotension
Hemoglobinuria
DIC, AKI
Management:
Aggressive IV fluids
Maintain urine output (± furosemide)
Treat DIC if present
---𝟮. 𝗙𝗲𝗯𝗿𝗶𝗹𝗲 𝗡𝗼𝗻-𝗛𝗲𝗺𝗼𝗹𝘆𝘁𝗶𝗰 𝗧𝗿𝗮𝗻𝘀𝗳𝘂𝘀𝗶𝗼𝗻 𝗥𝗲𝗮𝗰𝘁𝗶𝗼𝗻 (𝗙𝗡𝗛𝗧𝗥)
Onset: Within 1–6 hours
Cause:Cytokines OR recipient antibodies vs donor leukocytes
𝗙𝗲𝗮𝘁𝘂𝗿𝗲𝘀:
Fever (↑ ≥1°C from baseline)
Chills
NO hemolysis, NO hypotension
Management:
Antipyretics (paracetamol)
Exclude hemolysis before continuing
Prevention:Leukoreduced blood products
3. Allergic Reaction (Mild)
Onset: During or within 1 hour
Cause:IgE-mediated reaction to donor plasma proteins
𝗙𝗲𝗮𝘁𝘂𝗿𝗲𝘀:
Urticaria, pruritus
No systemic instability
Management:
Antihistamines
May restart transfusion if symptoms resolve
𝟰. 𝗔𝗻𝗮𝗽𝗵𝘆𝗹𝗮𝗰𝘁𝗶𝗰 𝗥𝗲𝗮𝗰𝘁𝗶𝗼𝗻 (𝗦𝗲𝘃𝗲𝗿𝗲)
Onset: Within minutes
Cause:IgA deficiency with anti-IgA antibodies
𝗙𝗲𝗮𝘁𝘂𝗿𝗲𝘀
Hypotension
Bronchospasm, respiratory distress
Angioedema
Management:
IM epinephrine (first-line)
IV fluids ± vasopressors
Prevention:Washed RBCs / IgA-deficient donor blood
𝟱. 𝗧𝗿𝗮𝗻𝘀𝗳𝘂𝘀𝗶𝗼𝗻-𝗥𝗲𝗹𝗮𝘁𝗲𝗱 𝗔𝗰𝘂𝘁𝗲 𝗟𝘂𝗻𝗴 𝗜𝗻𝗷𝘂𝗿𝘆 (𝗧𝗥𝗔𝗟𝗜) Acute Lung Injury (TRALI)
Onset: Within 6 hours
Cause:Donor antibodies → neutrophil activation → lung injury
Features:
Acute hypoxia
Bilateral infiltrates (CXR)
No fluid overload
Management:
Oxygen
Ventilatory support if needed
𝟲. 𝗧𝗿𝗮𝗻𝘀𝗳𝘂𝘀𝗶𝗼𝗻-𝗔𝘀𝘀𝗼𝗰𝗶𝗮𝘁𝗲𝗱 𝗖𝗶𝗿𝗰𝘂𝗹𝗮𝘁𝗼𝗿𝘆 𝗢𝘃𝗲𝗿𝗹𝗼𝗮𝗱 (𝗧𝗔𝗖𝗢)
Onset: Within 6 hours
Cause:Volume overload
Features:
Dyspnea
Hypertension (key!)
Pulmonary edema
Raised JVP
Management:
Diuretics (furosemide)
Slow/stop transfusion
𝗞𝗲𝘆 𝗱𝗶𝘀𝘁𝗶𝗻𝗰𝘁𝗶𝗼𝗻 𝗳𝗿𝗼𝗺 𝗧𝗥𝗔𝗟𝗜:
𝗧𝗔𝗖𝗢 → 𝗳𝗹𝘂𝗶𝗱 𝗼𝘃𝗲𝗿𝗹𝗼𝗮𝗱 (↑ 𝗕𝗡𝗣, 𝗛𝗧𝗡)
𝗧𝗥𝗔𝗟𝗜 → 𝗶𝗻𝗳𝗹𝗮𝗺𝗺𝗮𝘁𝗼𝗿𝘆 (𝗻𝗼𝗿𝗺𝗮𝗹 𝗕𝗡𝗣, 𝗻𝗼 𝗛𝗧𝗡)

Discontinuation of GLP-1-based therapy and cardiovascular risk (April 2026)
Interruption or discontinuation of glucagon-like peptide 1 (GLP-1)-based therapy is common and may result
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not only in weight regain but also in loss of the cardioprotective effects of treatment

Early administration of oral insulin to induce immune tolerance has been explored for
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primary prevention of type 1 diabetes.

Ambulatory Blood Pressure Monitoring:
European Society of Cardiology guidelines recommend at
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least
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20 day time
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and 7 nighttime readings
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or that at least 70% of scheduled readings are successfully performed for ABPM
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to be considered valid and clinically interpretable.

Importantly
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nighttime hypertension portends elevated risk of adverse
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kidney and cardiovascular outcomes beyond other BP parameters.
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However
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evidence is lacking on whether specifically targeting nighttime BP with treatment improves outcomes
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thus
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guidelines do not recommend treating based on nighttime BPs alone nor dosing medications at bedtime to address them.

Tirzepatide
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a glucagon-like peptide 1 (GLP-1)-based therapy
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reduces body weight
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and glycemia in adults with type 2 diabetes
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but its effects on atherosclerotic cardiovascular disease (ASCVD) outcomes have
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not been established.

Note: One gram of calcium carbonate is equal to 400 mg of elemental calcium.
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Calcium supplementation (OTC labeling):
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Oral: 500 mg to 4 g/day as calcium carbonate (equivalent to 200 mg to 1.6 g of elemental calcium)
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in 1 to 3 divided doses.
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Note: The recommended daily intake of elemental calcium (from dietary sources and supplemental sources if needed) for optimal
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bone health is 1.2 g/day (postmenopausal women)
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or 1 to 1.2 g/day in other adults.
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It is preferred to obtain these daily amounts primarily through dietary
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sources.
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There is no
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evidence that intakes higher than these improve bone strength (Ref).

Rabeprazole has minimal CYP2C19 influence
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given that most of its clearance is nonenzymatic

gastroesophageal reflux disease in children:
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patients who do not respond well to omeprazole may benefit
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from switching to
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esomeprazole or rabeprazole.

Acute Myocardial Infarction in Pregnancy
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