20. Blood Transfusion Reactions Flashcards
List the different kinds of transfusions.
What are some complications/adverse effects of transfusion?
What are the basic blood group serologies?
Whole blood (rarely used). Red cells (2 million units. For e.g. anaemia). Platelets (200,000 units). Plasma (fresh frozen (3-4 units/dose) or cryoprecipitate (10 units/dose)). Non UK plasma.
(pic)
ABO (A 42%. B 9%, AB 3%, O 46%), RhD group, other red cell antigens (e.g. Kell, other Rh antigens like c, E), red cell abs.
60 yr old Mr Smith had vascular surgery. Anaesthetist asked nurse to go and collect 2 units of blood from satellite fridge. First unit issued and labelled for Mr Smith (blood group O RhD +ve). Second unit issued and labelled for Mr Jones (blood group B RhD -ve).
Describe the reaction within Mr Smith when he receives the second unit.
ABO mismatch - complement activation. (pic)
Acute haemolytic reaction - wrong blood important cause of morbidity. Serious acute haemolytic reaction. Immedicate complete complement mediated lysis - shock, high fever, kidney failure, death.
How would you manage an acute haemolytic reaction?
What is a delayed haemolytic transfusion reaction?
What is FNHTR? (febrile non-haemolytic transfusion reaction)
STOP transfusion. IV fluids to maintain BP. FBC, coag screen, chemistry.
Repeat blood group pre and post samples. Return blood unit to blood bank. Blood cultures. Intensive care, treatement DIC, dialysis.
Due to red cell Abs - IgG (Rh system/Kell/FYa, JKb etc.). 7-10d post transfusion: failure of Hb to rise, jaundice. DAT +ve (direct antigobulin test). Higher rates in pts with sickle cel so give extended Rh and Kmatched blood.
During/soon after transfusion. Fever: temp increases >1oc +/- shakes or rigors, and pulse increase. Unpleasant but not life threatening. Most common transfusion reaction, due to inflammatory chemical signals released by WBC in donor blood. But less since leucodepletion of blood and platelets.
What 2 main allergic reactions may arise due to transfusion?
1) Urticarial rash +/- wheeze. Often not severe. Hypersensitivity to ‘random’ plasma protein. (pic)
2) Anaphylaxis. Severe, life-threatening soon after transfusion started. Wheeze/asthma, increased pulse, decreased BP (shock). Laryngeal oedema/facial oedema. May be related to IgA deficiency (rare).
What are 2 pulmonary complications of transfusion?
How do they compare with PA pressure and improvement with diuretic?
What are 2 rare immune complications of transfusion?
1) TACO: transfusion associated circulatory overload - most at risk = elderly, pre-existing heart disease, v. small pts. Assess pre-transfusion to ID risk via TACO checklist (pic).
2) TRALI: transfusion related acute lung injury - transfused anti-leucocyte abs in donor plasma can interact with pt’s WBC. Bilateral pulmonary infiltrate. Supportive management, ventilation
TACO: >18mmHg, improvement with diuretic
TRALI: ≤18mmHg, no improvement with diuretic
1) PTP: post transfusion purpura - 7-10d after (blood or platelets), HPA 1 -ve pts forms abs after transfusion/pregnancy. After further transfusion, destruction of own platelets.
2) TA-GVHD: transfusion associated graft-versus-host disease - rare, always fatal, mediated via viable lymphocytes in Donor’s blood transfused to immunocompromised host (e.g bone marrow transplant pts, chemo, Hodgkin’s, foetus, congeintal immunodef., if donor is HLA match). Prevented by giving irradiated blood and platelets - makes donor lymphocytes unable to divide.
List some infectious organisms that could be transmitted by transfusion.
How does the antifibrinolytic tranexamic acid work?
Ones that persist for long time in blood circulation - present in donated blood.
- *Viral** - Hepatitis (A, B, C, D), Retroviruses (HIV, HTLV, herpes, CMV, EBV, HHV8), Parvovirus B19.
- *Bacterial** - rare but can be fatal e.g. bacterial sepsis - esp if endotoxin produced e.g. G-ve rods (E.coli). Source donor skin!
- *Parasites**
- *Prions** - transmissable by blood in sheep and humans. No blood test presently available (only biopsy).
Treats/prevents excessive blood loss. Synthetic analog of aa lysine. Reversibly binds 4-5 lysine receptor sites on plasminogen/plasmin. This prevents plasmin (antiplasmin) from binding to and degrading fibrin and preserves the framework of fibrin’s matrix structure.
