AETIOLOGY Physically or Chemically Induced Transfusion Reactions (PCITR)
	INCIDENCE Unusual
	CLINICAL CULTURE These reactions may be caused by a variety of factors. They include Intra - vascular damage to the transfused RBC by hyper or hypotonic solutions; heat/cold damage to RBC during storage of pre - warming; citrate toxicity in massive transfusions; hypothermia due to massive infusions of cool fluids. The clinical picture is nonspecific. Commonly it includes: Chills, muscle twitching, numbness especially facial, nausea , vomiting, perioral tingling, cardiac arrythmais, altered respiration and anxiety.
	MANAGEMENT For correct management the following test are necessary: Serum electrolyte levels, ionised calcium levels, blood levels, blood glucose, urine analysis, haemoglobin, haematocrit, platelet count, protrombin time, activated partial thromboplastin time. 1. Treat the underlying cause. 2. Give supportive care for electrolyte imbalance and cardiac arrythmias. 3. Heparin may be necessary for DIC. 4. Oral calcium rich products may be required for citrate toxicity.
	PREVENTION Use blood warmers only when large amounts of blood/components are to be infused rapidly. Use platelet concentrates and FFP in patients who receive massive transfusions. Monitor patient's vital signs and mental status for early detection of electrolyte imbalance.