4.6 Transfusion Reactions Flashcards
A patient had a transfusion reaction to packed RBCs. The MLS began the laboratory investigation of the transfusion reaction by assembling pre- and post-transfusion specimens and all paperwork and computer printouts. What should the MLS do next?
Check for clerical error(s)
What is the pathophysiological cause surrounding anaphylactic and anaphylactoid reactions?
Patient is deficient in IgA and develops IgA antibodies via sensitization as a result of transfusion or pregnancy
A patient has a hemolytic reaction to blood transfused 8 days ago. What is the most likely cause?
Delayed immunologic, probably as a result of an antibody such as anti-Jka
What may be found in the serum of a person who is exhibiting signs of transfusion- related acute lung injury (TRALI)?
Antileukocyte antibody
Which type of transfusion reaction occurs in about 1% of all transfusions, results in a temperature rise of greater than 1°C above 37°C associated with blood component transfusion, and is not related to the patient’s medical condition?
Febrile nonhemolytic reaction
What would be the result of group A blood given to a group O patient?
Immediate hemolytic transfusion reaction
Patient DB received 2 units of group A-positive RBCs 2 days ago. Two days later, he developed a fever and appeared jaundiced. His blood type was A positive. A transfusion reaction workup was ordered. There were no clerical errors detected. A post- transfusion specimen was collected and a DAT performed. The DAT result was positive with monospecific anti-IgG. The plasma was also hemolyzed. An antibody screen and panel studies revealed the presence of anti-Jkb in the post-transfusion specimen. The antibody screen on the pretransfusion specimen was negative. Which of the following explains the positive DAT?
The donor cells were likely positive for the Jkb antigen
All of the following are part of the preliminary evaluation of a transfusion reaction, except:
A. Check pre- and post-transfusion samples for color of serum
B. Perform ABO and Rh recheck
C. Perform DAT on the post-transfusion sample
D. Perform a panel on pre- and post-transfusion samples
Perform a panel on pre- and post-transfusion samples
A 68-year-old female diagnosed with neutropenia and inflammation of the left hand was typed as A positive and received 1 packed RBC unit. The antibody screen was negative,
and crossmatch was compatible. During the transfusion, her pulse was 94, and blood pressure (BP) rose from 114/59 mm Hg to 132/64 mm Hg. Temperature rose from 37.1°C before transfusion to 37.8°C 60 minutes after starting transfusion and then to 38.3°C upon completion. A post-transfusion specimen yielded plasma that was neither hemolyzed nor icteric, and a negative DAT. Post-transfusion urinalysis showed 1+ blood and protein with 10 RBCs/high-power field (hpf) microscopically. The clerical check result was acceptable. What type of reaction most likely occurred as a result of transfusion?
Febrile nonhemolytic
A 92-year-old male diagnosed with anemia and episodes of frequent falling was typed as B negative and transfused with 1 unit of packed RBCs, also B negative. He had not been recently transfused, and the antibody screen was negative. During the transfusion, his temperature rose from 36.2°C to 36.4°C, his pulse from 96 to 124, respirations from 18 to 20, and BP from 127/81 mm Hg to 174/83 mm Hg. He was transfused with 205 mL before a reaction was called by the transfusionist. The post-transfusion specimen DAT result was negative, and the clerical check result was acceptable. Urinalysis showed 1+ blood with 5 RBCs microscopically. Other symptoms included tachycardia and flushing. What reaction had most likely taken place?
Volume overload
A 76-year-old female diagnosed with urosepsis was transfused with 2 units of packed RBCs. Her type was AB positive and she had a negative result on antibody screen. The units transfused were AB positive. Upon receiving the second unit, the patient became hypoxic with tachypnea. The clerical check result was acceptable, and the DAT was negative. She received 269 mL from the second unit before a reaction was called. Her temperature fell from 38°C to 36.4°C, her pulse increased from 72 to 90, and respirations rose from 35 to 41. Her BP was 110/70 mm Hg. The patient died approximately 12 hours after the reaction was called. What type of reaction was most likely present?
Symptoms not related to transfusion
A 52-year-old male received 2 units of packed RBCs as an outpatient in the intravenous (IV) therapy unit. He had had a head trauma 20 years ago and was quadriplegic. He had recurrent pneumonia and hematuria as a result of removal of a Foley catheter. His blood type was A positive, with previously identified anti-Fya. There was an ABO discrepancy, in that reverse typing with reagent A1 cells was positive. The MLS attributed this reaction to Fya antigen being present on the reagent A1 cells. The patient also had a cold autoantibody. Two units of A-positive packed cells were crossmatched that were Fya negative and were compatible. One unit was transfused at 11:30 a.m. without incident. The second unit was transfused at 2:16 p.m. and stopped at 3:55 p.m. because of reddish brown–tinged urine found in his collection bag. A post-transfusion specimen yielded a positive DAT and plasma that was grossly hemolyzed. A prewarm crossmatch was incompatible in both the pre- and post-transfusion specimens. Anti-E and anti-c were present in the post-transfusion specimen. What reaction was most likely present?
Acute hemolytic
An 82-year-old male was admitted for renal failure. His type was B positive, and his antibody screen was negative. Two units of RBCs were ordered. The first unit was transfused at 1:00 p.m. without incident. The second was started at 4:15 p.m. and stopped at 5:12 p.m. after the nurse observed that the patient had died. Vital signs had been taken at 4:30 p.m. with no abnormalities. A transfusion reaction was called and the blood unit, tubing, and paperwork sent to the blood bank. There were no clinical manifestations noted on the paperwork, and no post-transfusion specimen was sent to the blood bank. What type of reaction most likely occurred?
Cause not related to transfusion
