Adverse Effects Flashcards
an unintended and deleterious occurrence associated with blood component transfusion. It may occur before, during, or after a transfusion
adverse event
Adverse events include
incidents and adverse reactions
is any error that could affect the quality or effectiveness of a blood product or could have led to an adverse reaction to a transfusion recipient.
incident
harmful effect observed in a transfusion recipient that is temporally associated with a blood component transfusion.
adverse reaction
most common causes of deaths associated with transfusion recipients.
Transfusion-related acute lung injury (TRALI)
transfusion-associated circulatory overload (TACO)
transmission-transmitted bacterial
TRANSFUSION SERVICE: Laboratory Technologist
Laboratory Technologist:
• Perform primary testing on postreaction sample
• Report findings to the transfusion service physician
• Perform additional testing as per transfusion service physician orders
TRANSFUSION SERVICE: Physician Responsibilities:
Transfusion Service Physician:
• Evaluate initial transfusion reaction workup
• Order additional testing as needed
• Report to patient physician immediately if hemolysis, bacterial contamination, TRALI, or other serious adverse event related to transfusion is suspected
• Generate a final transfusion report, including interpretation of the transfusion reaction and recommendations for future transfusions
• Notify blood center and other outside agencies if applicable
collection of information on the complications of transfusion, analysis of these data, and subsequent data-driven improvements in transfusion practices.
Hemovigilance
development of non-ABO anti- bodies following RBC transfusion, pregnancy, or transplan- tation.
Alloimmunization
alloimmunization is much higher,30% or greater in
chronically transfused patients with sickle cell disease
myelodysplastic syndrome
thalassemia, or autoimmune hemolytic disease.
The risk of an individual patient developing a non-ABO alloantibody depends upon many factors, such as
including the patient’s underlying diseases, the cause of anemia, the cumulative number of transfusions, and the immunogenicity of the non-self RBC antigens to which the patient is exposed.
accelerated destruction of trans- fused RBCs due to antibody-mediated incompatibility.
AHTR Acute Hemolytic Transfusion Reaction
defined as the combination of signs and symptoms associated with hemolysis, biochemical evidence of hemolysis, and serologic evidence of RBC incompatibility occurring dur- ing or within 24 hours after transfusion
Acute HTR
Any unfavorable and harmful transfusion related events occurring in the patient during or after transfusion of blood or components is
Transfusion reaction
COMMON CAUSES OF TR
• Misidentification of the patient.
• Improper sample identification.
• Wrong blood issued.
• Administration error.
• Technical error.
• Storage error.
TYPES OF TRANSFUSION REACTIONS
Acute TR
Dleayed TR
occurs within 24 hours post transfusion.
Acute TR
develops after 24 hours post transfusion.
Delayed TR
most severe type of transfusion reactions
Hemolytic Transfusion Reaction
HTR categorized into two types
Immediate HTR/ Intravascular HTR
Delayed HTR/ Extravascular HTR
Reaction takes place within the circulatory system.
IHTR or Intravascular HTR
Hemolysis occur within few min after starting transfusion (<24 hrs)
IHTR OR INTRAVASCULAR HTR
Due to IgM Abs, mediated by the rapid activation of complement and is usually associated with the transfusion of ABO in incompatible blood.
IHTR OR INTRAVASCULAR HTR
SIGNS and SYMPTOMS HTR
Fever
Chills
Hypotension
Chest and Back pain
Nausea
Dyspnea
Vomiting
Hemoglobinuria
Acute renal failure
Pain at transfusion
Shock and DIC
agent used to prevent the renal failure.
Mannitol
Hypotension HTR management and therapy
intravenous fluid and vasoactive drugs .e.g. dopamine
are rarely severe and mainly due to IgG antibodies, e.g. Rh, kell or Duffy system.
Delayed HTR/ Extravascular HTR
These ab’s bring about the destruction of red cells by the macrophages in the spleen or liver.
Delayed HTR/ Extravascular HTR
In delayed htr, Hemolysis occur after few hours or after about
3-7 days
Delayed HTR/ Extravascular HTR could be due to
ALLO-IMMUNIZATION or ANAMNESTIC RESPONSE
What is ALLOIMUNIZATION ?
an immune response to foreign antigens from another human, most commonly occurring after pregnancy or blood transfusions.
Factors influencing the rate of alloimmunization are:
• antigenic differences
• dose
• frequency of transfusion
• recipient immune status, and
• immunogenicity of the donor HLA antigens
Any immunological response in which a second or subsequent exposure to an antigen causes a greater and more rapid reaction than that elicited by the initial exposure. It is a manifestation of immunological memory.
ANAMNESTIC RESPONSE-
SIGNS and SYMPTOMS of alloimmunization
• Fall in Hgb
• Rise in bilirubin
• Mild jaundice within 5-7 days post transfusion
• Renal failure (rare)
NON HEMOLYTIC TRANSFUSION REACTIONS
• Febrile Non Hemolytic TR (FNHTR)
• Urticarial TR (allergic)
• Anaphylactic TR
• Transfusion- Related Acute Lung Injury (TRALI)
• Transfusion Associated Circulatory Overload (TACO) • Graft Versus Host Disease (GVHD)
These reactions are the most common and account for over 90 % of TR.
Febrile Non Hemolytic TR (FNHTR)
↑ temperature, >1 CC
Febrile Non Hemolytic TR (FNHTR)
These are benign, self-limiting reaction due to the presence of ab’s to WBC or PLT antigens and are usually seen in multi transfused patients.
Febrile Non Hemolytic TR (FNHTR)
Therapy and Prevention of FNHTR
• give leukocyte poor red cells.
• Anti-pyretic can be given before starting transfusion, but they must be avoided as much as possible as they mask IHTR.
A type of immediate hypersensitivity reaction.
URTICARIAL (ALLERGIC) TR
CAUSES of URTICARIAL TR
• The donor’s plasma contain allergens which react with reagin present in patient’s plasma.
• The donor’s plasma contains reagin that combines with allergens in the patient plasma.
This is a severe, life-threatening reaction, which occur in rare patients who are IgA deficient and have developed anti-IgA ab’s.
ANAPHYLACTIC TR
TRANSFUSION RELATED ACUTE LUNG INJURY
(TRALI) also known as
non cardiac pulmonary edema
Altered permeability of the pulmonary capillary bed by activation of complement, histamine mediated events, or prostaglandins which leads to fluid accumulation, inadequate oxygenation, and reduced cardiac return.
TRANSFUSION RELATED ACUTE LUNG INJURY
(TRALI)
antibody mediated, one-hit event. Antibody against Human Leukocyte Antigen (HLA) or Human Neutrophil Antigen (HNA) react with recipient’s leukocytes, causing aggregates that occlude the pulmonary circulation.
Immune TRALI
consists of a two-hit event. The first hit (i.e., lung trauma or an infectious or inflammatory disease in the patient) may result in priming of the patient’s neutrophils. Therefore, a proinflammatory priming event of the patient’s endothelium, which primes the patient’s neutrophils. The second hit (i.e., transfused biologically active substances accumulated during storage or antileukocyte antibodies) causes the activation of the primed neutrophils.
Nonimmune TRALI
Occur with platelet concentrate transfusion.
POST TRANSFUSION PURPURA (PTP)
Rapid onset of thrombocytopenia due to production of platelet alloantibodies.
Post Transfusion Purpura
Duration of PTP
7-14 days from transfusion.
Therapy for PTP
Corticosteroids
• Complication of blood component therapy or bone marrow transplantation
GRAFT versus HOST DISEASE (GVHD)
Patients at risk of GVHD
• Lymphopenic patients
• Bone marrow suppressed cases
• Fetus receiving intrauterine transfusion
• Newborn infants receiving exchange transfusion
• Congenital immunodeficiency syndrome
NON IMMUNE, NON HEMOLYTIC TR immediate
Bacterial Overload
Circulatory overload
NON IMMUNE, NON HEMOLYTIC TR delayed
Iron overload
acute nonimmune transfusion reaction presenting with body temperatures usually 2°C or more above normal and rigors that can be accompanied by hypotension.
TRANSFUSION- ASSOCIATED SEPSIS (TAS)
occurs when a bacteria-contaminated blood component is transfused.
TRANSFUSION-ASSOCIATED SEPSIS
IRON OVERLOAD also known as
transfusion haemosiderosis.
Long term complication of RBC transfusion
Iron overload
