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Y1 - Path - Exam 5 > 6. Transfusion Continued > Flashcards

6. Transfusion Continued Flashcards

1
Q

what are reactions from a transfusion?

define and examples

A
  • Any combination of sxs, clinically observable signs, and/or lab
    derangements that are potentially attributable to a blood transfusion
  • Examples
    • Signs: **Fevers, hypotension
    • Symptoms: Shortness of breath, nausea
    • Labs: ↑LDH, hemoglobinuria
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2
Q

how much transfusion product can yield a reaction?

A

a rxn can occur w/ any amount of any blood product

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3
Q

when should you report reactions to blood blank?

A
  • beneficial to have high index of suspicion and low threshold for reporting
  • reactions reported to blood back are immediately investigated
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4
Q

if a transfusion reaction is suspected, what do you do?

A
  1. STOP THE TRANSFUSION;
    • each additional drop can exacerbate it;
  2. AFTER stopping transfusion
    1. address specific rxn
    2. leave all SALINE lines open
    3. confirm patient ID and blood product information match
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5
Q

how are transfusion rxns categorized?

A

Acute/ delayed

Fever/ no fever

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6
Q

what causes a hemolytic reaction?

A
  • Due to serologic incompatibility between the recipient’s blood and the transfused donor blood –> complemet fixation –> INTRAVASCULAR RBC lysis
    • Most often: Recipient’s pre-existing antibodies interact with corresponding antigens on donor RBC’s
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7
Q

timing and most common situation associated with ACUTE HEMOLYTIC RXN?

A
  • Acute – within 24 hours of transfusion
  • Classical situation: mis-tranfusion
    • e.g. Group A patient (w/ naturally occurring anti-B antibody) is erroneously transfused group B RBCs
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8
Q

signs and sxs associated w/ Acute Hemolytic Reactions

A
  • ** Fever, chills/rigors - most common; earliest sign
  • Tachycardia
  • Back/flank pain
  • Pain at infusion site
  • Gross hemoglobinuria, oliguria
  • Hypotension, shock, multi-organ failure (MOF) – Potentially fatal
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9
Q

what lab findings may be associated with Acute Hemolytic Transfusion rxns?

A
  • Labs suggesting hemolysis (↑LDH, ↓haptoglobin, etc.)
  • May also see labs suggesting DIC (↓fibrinogen, etc.
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10
Q

How to treat Acute Hemolytic Rxns?

A
  • STOP TRANSFUSION; Mis-transfused blood can not be removed
  • Tx goals
    • preserve and maintain renal fxn
    • hydration and diuresis
    • blood pressure and respiratory support
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11
Q

what is the pathophysiology of a delayed hemolytic reactions?

A
  1. Recipient previously immunized to an RBC antigen
    • Antibody strength wanes over time → Undetectable
  2. Re-exposure to the same antigen (transfusion)
    • Antibody strength increases – anamnestic response
    • Antibodies interact with donor antigens
    • Opsonization → Extravascular RBC lysis
  3. Delayed rxn – within 1 to 28 days after transfusion
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12
Q

signs and symptoms, and lab findings of DELAYED HEMOLYTIC RXN?

A
  • Signs/sxs – MUCH LESS SEVERE THAN ACUTE HEMOLYTIC RXN
    • fevers/ chills
    • fatigue
    • jaundice
    • oftentimes entirely asymptomatic
  • Lab findings
    • dec hemoglobin/hematocrit
    • offending antibody is detected
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13
Q

what are the treatment goals of delayed hemolytic rxn?

A
  • Supportive management only
  • No long-term clinical sequelae
  • Offending antibody should be accounted for in future transfusions
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14
Q

what are dyspneic reactions?

A

Transfusion rxns can present with dyspnea/ shortness of breath

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15
Q

what is the differential diagnosis when dyspnea is the primary sign of transfusion rxn?

A
  • Transfusion-associated circulatory overload (TACO)
  • Transfusion-related acute lung injury (TRALI)
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16
Q

what is the pathophysiology of TACO?

(transfusion-associated circulatory overload)

A
  1. transfusion into easily fluid-overloaded system
    • (**e.g. pre-existing CHF particularly at risk)
  2. Inc Preload, Inc Afterload
  3. Transudate fluid backs up into lungs (Cardiogenic pulm edema)
17
Q

what is the signs/symptoms and lab findings of TACO?

(transfusion-associated circulatory overload)

A
  • signs/sxs
    • **HTN
    • **may see inc jugular venous pressure and/or edema
    • acute dyspnea, shortness of breath
    • hypoxemia
  • lab findings
    • inc BNP (compared to pre-transfusion)
    • (recall: B-type natriuretic peptide (BNP) is a hormone produced by your heart)
18
Q

what is the radiological findings of TACO?

(transfusion-associated circulatory overload)

A
  • pulmonary vascular congestion
  • IF SEVERE –> diffuse bilat infiltrates
19
Q

what is the tx for TACO?

(transfusion-associated circulatory overload)

A
  • **diuresis –> to decrease fluid overload
  • respiratory support (intubation, ventilation)
  • slower rate of future transfusions
20
Q

what is the pathophysiology of TRALI?

(Transfusion-related acute lung injury)

A
  1. pre-existing anti-HLA antibodies in transfused blood
  2. antibodies interact w/ recipient’s neutrophils in pulmonary capillaries
  3. exudate fluid leaks into lungs (non-cardiogenic pulm edema)
21
Q

what is the leading cause of transfusion-associated fatality?

A

TRALI

(transfusion-related acute lung injury);

trali is much more rare than TACO (taco is more common)

this is more a donor issue; theory is that there are pre-existing donor products are the causeof TRALI

22
Q

signs/sxs of TRALI

(transfusion-related acute lung injury);

A
  • May see fever and hypotension
  • No evidence of circulatory overload (TACO must be ruled-out)
  • Acute dyspnea, shortness of breath
  • Hypoxemia
23
Q

lab and xray findings of TRALI

(transfusion-related acute lung injury);

A
  • Lab findings: no specific findings
  • Radiology findings (CXR): diffuse bilateral pulmonary infiltrates
24
Q

what is the treatment of TRALI?

(transfusion-related acute lung injury);

A

Treatment

  • WILL NOT IMPROVE W/ DIURESIS
  • Respiratory support (intubation, ventilation)
  • other supportive care as needed

If recognized properly and early –> usually resolved in 3-7 days

25
Q

what is the pathophysiology of an ALLERGIC TRANSFUSION REACTIONS?

A
  • TYPE I (immediate) hypersensitivity rxn
  • due to re-exposure to soluble antigens in transfused blood which act as allergens

Range in severity from mild urticaria –> life-threatening anaphylaxis

26
Q

signs/sxs and lab findings of ALLERGIC TRANSFUSION RXNs

A
  • Signs/symptoms:
    • pruritis
    • range of involvement for skin and mucous membranes (hives, rash, edema)
    • possible airway edema
    • possible hypotension or shock
  • Lab findings: no specific dinginds
27
Q

treatment of ALLERGIC TRANSFUSION RXNs

A
  • supportive care for mild-to-moderate rxns
    • antihistamines and/or corticosteroids as needed
    • blood pressure and/or respiratory support as needed
  • for anaphylaxis –> epinephrine
28
Q

what is the pathophysiology of FEBRILE NON-HEMOLYTIC REACTIONS?

A

Pyrogenic cytokines in the donor blood product –> cause TRANSIENT FEVERS AND CHILLS;

**this is a diagnosis of exclusion – if all other reasonable causes for fever have been ruled out

29
Q

what are the signs/symptoms and labs of

FEBRILE NON-HEMOLYTIC REACTIONS?

A

Signs/sxs

  • fever (at least >1 degree celsius, or 1.8 degrees fahrenheit)
  • chills, rigors

Lab findings: none specific

30
Q

what is the treatment for

FEBRILE NON-HEMOLYTIC REACTIONS?

A
  • Acetaminophen as needed
    • fever reducer
  • Meperidine can be used for rigors (uncommon practice)
    • Recall: rigors are a sudden feeling of cold with shivering accompanied by a rise in temperature, often with copious sweating, especially at the onset or height of a fever
  • Supportive care

Y1 - Path - Exam 5 (4 decks)

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