Adverse Effects of Blood Tansfusion Flashcards
What are the different classifications for the Adverse effects of Transfusion?
- Immunologic vs Non- Immunologic
- Immediate ( usually less than 24 hours) vs Delayed ( days- years)
- Haemolytic vs Non Haemolytic
What are the examples of the IMMUNOLOGIC Adverse Transfusion reactions that are IMMEDIATE ?
- Immediate Haemolytic
- Non- Haemolytic Febrile Transfusion Reaction (NHFTR)
3.Allergic
4.Transfusion-related acute lung injury (TRALI)
What are the examples of the NON- IMMUNOLOGIC Adverse Transfusion reactions that are IMMEDIATE ?
1.Transfusion-associated circulatory overload (TACO)
2.Transfusion-associated sepsis (TAS)
3. Massive Transfusion
What are the examples of the IMMUNOLOGIC Adverse Transfusion reactions that are DELAYED ?
1.Delayed Haemolytic
2. Graft vs Host Disease
What are the examples of the NON- IMMUNOLOGIC Adverse Transfusion reactions that are DELAYED ?
- Transfusion hemosiderosis (Iron overload)
- Disease transmission
What are the examples of IMMUNOLOGIC Adverse Reactions?
- Haemolytic ( Immediate or Delayed)
- Non- Haemolytic Febrile Transfusion Reaction (NFTR)
- Transfusion-related acute lung injury (TRALI)
4.Allergic - Graft versus Host disease (GVHD)
What are the examples of NON- IMMUNOLOGIC Adverse Reactions?
- Transfusion associated Sepsis (TAS)
- Transfusion associated Circulatory Overload (TACO)
- Massive transfusion
- Transfusion hemosiderosis (Iron overload)
Which antibody is associated with Immediate Haemolytic Transfusion reaction (IHTR)?
IgM
True or False? Immediate Haemolytic Transfusion reaction (IHTR) is associated with Intravascular Haemolysis while Delayed Haemolytic Transfusion reaction
(DHTR) is associated with Extravascular Haemolyisis.
TRUE!!! I for Immediate , I for Intravascular
What is the antibody associated with Delayed extravascular haemolysis of transfused red cells (DHTR)?
IgG
Fill in the blanks. “ In Immediate Haemolytic Transfusion reaction
(IHTR) there is ____________ activation of Complement while in Delayed extravascular haemolysis of transfused red cells (DHTR) there is ___________ activation of Complement.”
In Immediate , there is COMPLETE activation of Complement.
In Delayed , there is PARTIAL activation of Complement.
What is the time period for a reaction in DHTR?
5-10 days.
How can one Prevent Immediate Haemolytic Transfusion reaction
(IHTR)?
Avoid errors (most likely cause for IHTR); ensure proper sample, recipient and blood unit identification
What are the clinical features of Immediate Haemolytic Transfusion reaction (IHTR)?
*Fever
*Pain at iv site
*Back or chest
*Red urine (haemoglobin)
*Diffuse bleeding (DIC)
*Hypotension
What are the clinical features associated with Delayed extravascular haemolysis of transfused red cells (DHTR)?
- 75% of Rh D negative patients exposed to Rh D positive blood will develop anti-RhD
*Patients chronically transfused are at increased risk eg SCD
- Symptom of anaemia, jaundice
How can one prevent Delayed extravascular haemolysis of transfused red cells (DHTR)?
- Extended phenotyping of patient’s rbc
- Inform the Blood Bank of this incident.
- Patient requires antigen-negative red cells for future transfusions
What is the Cause of Non-Haemolytic Febrile Reactions (NHFTR) to transfusion of platelets and red cells?
- Cytokine Release - IL-1 , IL-6 , TNF
- Ab (HLA) to donor Leukocyte Ag
What is the time period for a reaction in NHFTR?
Less than an hour
What is the treatment for NHFTR?
Antipyretic (Paracetamol).
How can one prevent Non-Haemolytic Febrile Reactions (NHFTR) to transfusion of platelets and red cells?
*Pretransfusion antipyretics
* Use pre-storage leukocyte-reduced cellular components
What is the Two-Hit hypothesis associated with Transfusion Related Acute Lung Injury (TRALI) Non-cardiogenic pulmonary oedema?
A) Priming/recruitment of neutrophils due to stress, sepsis, shock, surgery and resultant increase in IL6 and IL8.
B) Donor plasma has bioactive lipids and antibodies (HLA) to recipient leukocyte antigens ——> activate neutrophils —-> degranulation ——->
pulmonary oedema
What is the time period associated with Non-Haemolytic Febrile Reactions (NHFTR) to transfusion of platelets and red cells?
- Onset during or within 6hr
What are the clinical features associated with Transfusion Related Acute Lung Injury (TRALI)?
- Life threatening.
Acute respiratory distress, fever, chills, dyspnea, cyanosis; - CXR - diffuse pulmonary infiltrates
Diagnosis of exclusion
What is the treatment for Transfusion Related Acute Lung Injury (TRALI)?
Stop transfusion, respiratory support. Diuretics and steroids are NOT effective
How can Transfusion Related Acute Lung Injury (TRALI) be prevented?
Avoid transfusion of plasma components from multiparous female donors.
Which antibody is associated with the allergic reactions from transfusions?
IgE
What are the clinical features for Allergic transfusions reaction?
Itching
Urticaria ( hives)
Rarely anaphylaxis – hypotension
Dyspnea
Wheezing
Shock
Cardiac arrest
What is the treatment for Allergic reactions to transfusion?
Temporarily stop infusion and give antihistamine.
Discontinue transfusion for severe reactions,
give epinephrine, oxygen, steroid
How can Allergy transfusion reactions be prevented?
Pretransfusion antihistamine; wash RBC components with normal saline if severe or recurrent.
What are complications of Transufusion reactions due to iron overload?
- Liver damage
- Endocrine problems – Diabetes mellitus,
- Hypothyroidism
- Cardiac dysfunction
How is transfusion reactions due to iron overload treated?
Use iron chelating agent to increase iron excretion
A too rapid and/or excessive blood transfusion overwhelm lymphatics resulting in pulmonary oedema causes which Adverse transfusion reaction?
Transfusion-associated Circulatory overload
(TACO)
How can Transfusion-associated Circulatory overload (TACO) be prevented?
*Avoid transfusion unless absolutely indicated especially in patients with chronic anaemia.
- Slow rate of transfusion in at risk patients to 1ml/kg/hr
What are the infectious agents that may be transmitted by blood transfusion ?
Hepatitis B, C
HIV
HTLV
CMV
Malaria
How can Diseases transmitted by blood products be prevented?
Donor screening and deferral, limit use of blood, leukoreduction of blood (reduces CMV transmission), recombinant blood products, viral inactivation of plasma
Transfusion-associated sepsis (TAS) is most commonly seen in ?
Platelet concentrates
Transfusion-associated sepsis (TAS) can also be seen in whole blood and packed red cell. How is this possible?
- Cells may be contaminated with bacteria eg, Staphylococcus via poor cleaning of donor arm
- Asymptomatic donor bacteremia
*During laboratory procedures
When does Transfusion-associated sepsis (TAS) normally occur?
Usually during infusion of first 100 ml of contaminated pack.
What are the clinical features of Transfusion-associated sepsis (TAS)?
- Renal failure
- Septic shock
- DIC
- Very high mortality of high bacterial count
How can one treat Transfusion-associated sepsis (TAS)?
Discontinue transfusion. Blood cultures from blood bag and recipient.
Manage septicemia
How can Transfusion-associated sepsis (TAS) be prevented?
Donor screening, proper cleansing of donor arm, adequate storage of blood components, red cell transfusion should not continue beyond 4 hours
What are the clinical features of Transfusion-associated GVHD (Ta-GVHD)?
- Rare
- Fever, rash, diarrhea
- Liver dysfunction occurring about 10 days after transfusion
How can one prevent Transfusion-associated GVHD (Ta-GVHD)?
Irradiation of cellular blood components
What is the pathogenesis associated with Transfusion-associated GVHD
(Ta-GVHD)?
Immunocompetent lymphocytes in cellular blood components engraft and proliferate in immunodeficient host and attack the host tissues – skin, liver, GIT, Bone marrow
What actions should be taken if Immediate Haemolytic Transfusion reaction is confirmed?
- Monitor renal status
- If disseminated intravascular coagulation (DIC) develops give blood components guided by clinical state and coagulation screen results
- If the patient needs further transfusion, use matched blood
- Monitor signs of haemolysis (Increase bilirubin, Increase LDH, Decreased haptoglobin)
What are the investigations that should be carried out if Immediate Heamolytic Transfusion reaction is suspected?
1). Stop the transfusion immediately
(To minimize the amount of blood transfused
and decrease the potential adverse reaction).
2). Maintain venous access with 0.9% NaCl (normal saline) to prevent acute oliguric renal failure.
3) Diuretic (fluid challenge). Insert bladder catheter and monitor urine output (>100ml/hr).
4). Check again that the information on the compatibility label of the blood unit corresponds with the patient’s ID wristband. Inform the blood bank urgently of the adverse event!
5) Take blood samples for
a. CBC (plasma haemoglobin)
b. Direct Coombs’ test on post-transfusion sample
c. ABO and Rh group on pre- and post-transfusion samples and donor blood
d. Repeat Crossmatch
e. Coagulation screen - PT, PTT, TT, fibrinogen (DIC)
f. Chemistry –urea, creatinine, electrolytes
g. Blood cultures from blood bag and patient – if bacterial contamination suspected.
6) Check post-transfusion urine sample for haemoglobinuria
7) Return blood pack(s) and administration set to the Blood Bank.
What are the categories of Autologous Blood Donation?
- Preoperative collection
- Acute Normovolemic Hemodilution
- Intraoperative collection
- Postoperative collection
What are the advantages of Preoperative collection ?
- Prevents transfusion transmitted diseases
- Prevents red cell alloimmunization
- Supplements the blood supply
What are the disadvantages of Preoperative collection ?
- Does not affect the risk of bacterial contamination or ABO incompatibility error.
- Is more costly than allogeneic blood
- Results in wastage of blood not transfused as strict selection criteria not adhered to
- Subjects patients to perioperative anaemia and increased likelihood of transfusion
What is Acute Normovolemic Hemodilution?
Removal of whole blood from a patient while restoring the circulating blood volume with an acellular fluid (crystalloid/colloid) shortly before an anticipated significant surgical blood loss.
What are the advantages of Acute Normovolemic Hemodilution?
- Procurement and administration costs are minimized – on site collection.
- Does not require the commitment of patient time, transportation and loss of work.
- Wastage is minimized
- No testing required
- Hemodilution reduces red cell loss
Which surgical procedures are normally involved with Post- Operative Collection?
Open Heart Surgery & orthopaedic surgery
