Adverse Effects of Blood Transfusion Flashcards
Most common adverse reactions
allergic transfusion reactions & febrile non-hemolytic transfusion reactions
Consistently the leading and most common transfusion reactions associated with mortality
TRALI & TACO
Most common cause of deaths associated with transfusion recipients
TRALI, TACO, TTBI
An essential transplant of foreign cells, always comes with risks
blood transfusion
What are the two critical components involves in the recognition and evaluation of suspected transfusion reaction?
- clinical recognition by the person administering the transfusion (nurse/physician)
- laboratory investigation of transfusion reaction (lab tech/med tech)
What is the first step once transfusion reaction is suspected?
IMMEDIATELY STOP TRANSFUSION
Majority of AHTRs is due to:
ABO incompatibility
Fatal transfusion reactions are mostly caused by:
clerical errors
What component is the most frequently involved with transfusion-associated sepsis?
platelets
Which blood product is easily contaminated?
platelets
Pain at the infusion site and hypotension are observed with what type of reaction?
AHTR
A suspected transfusion-related death must be reported to:
FDA
It is the development of non-ABO antibodies following transfusion, pregnancy, or transplantation.
Alloimmunization to RBC antigens
NHSN HEMOVIGILANCE
A combination of signs and symptoms associated with HEMOLYSIS, bichemical evidence of hemolysis, and serologic evidence of RBC incompatibility occurring during or within 24 hours after transfusion.
AHTR
An accelerated destruction of transfused RBC due to antibody-mediated incompability
AHTR
The severity of this transfusion reaction is related to the amount of incompatible blood transfused.
AHTR
Fever is its most common cause which often occurs with chills and rigors. Also, another frequent symptom is pain at the infusion site.
AHTR
A positive DAT 24 hours to 28 days after transfusion with either a positive eluate or a newly identified alloantibody in the plasma or serum and an evidence of hemolysis
DHTR
Most of its cases appear 7 to 10 days post-transfusion with either positive eluate or a newly identified alloantibody in the plasma and serum with an evidence of hemolysis.
DHTR
It has the same serologic findings as DHTR, but without hemolysis.
DSTR
List evidences of hemolysis.
- inadequate rise in hemoglobin
- rapid drop in hemoglobin to the pretrasfusion level
- appearance of spherocytes
- biochemical evidence of hemolysis
Early manifestation of AHTR can be confused with:
FNHTR
It is the ONLY presenting sign that often accompany DHTR
unexplained decrease in hemoglobin
A transfusion reaction associated with fever, macupapular rash, watery diarrhea, abnormal liver function, and pancytopenia.
TA-GVHD
Lists key reasons for non-immune hemolytic transfusion reactions
- improper shipping or storage temp
- incomplete deglycerolization
- inaappropriate needle bore size
- improper use of blood warmers
- unapproved fluid infusion
A rare event associated with acute respiratory distress
TRALI
It is the leading cause of mortality due to adverse reactions to transfusion
TRALI
NHSN HEMOVIGILANCE
What are the NHSN hemovigilance definitions of TRALI?
- Absence of ALI
- ALI during or within 6 hrs after transfusion
- Evidence of HYPOXEMIA by blood gas or oxygen saturation testing
- Radiographic evidence of bilateral pulmonary edema
- Exclusion of circulatory overload and other causes of pulmonary edema
TRUE OR FALSE
Plasma from multiparous female donors may carry a greater risk of TRALI
TRUE
a strong association with previously pregnant female donors
It has been attributed to the presence of antbibodies in the plasma of the transfused unit that are directed against HLA or granulocytes antigens present on recepients leukocytes.
TRALI
What should you give to your patient if you wanted to prevent TRALI?
leukoreduced red blood cells
Designated when the given criteria for TRALI are present but another cause of ALI is also identified.
possible TRALI
When the criteria for TRALI is present but onset is 6-72 hours
delayed TRALI
Presence of three or more features of fluid overload occurring within 6 hrs after transfusion.
TACO
An acute respiratory distress from pulmonary edema due to:
* excessive transfused fluid
* too rapid infusion rate
* inability to accomodate volume of transfused products
TACO
Due to rapid or excessive administration of blood wihtout compensatory mechanisms involved, usually iatrogenic.
TACO
Risk groups for TACO
- children
- elderly
- cardiac patients
- chronically-anemic patients
Management for TACO
- therapeutic phlebotomy
- IV diuretics
- O2 therapy
What are the defining features of TACO?
- Acute respiratory distress
- Elevated BNP
- Elevated central nervous pressure
- Evidence of left heart failure
- Evidence of positive fluid balance
- Radiographic evidence of pulmonary edema
List AABB requirements for laboratory investigation of a transfusion reaction.
- Clerical check of the component bag, label, paperwork, and pretransfusion patient specimen.
- Repeat ABO testing on the post-transfusion sample.
- Visual check of the pre- and post-transfusion specimens for hemolysis.
- Direct antiglobulin test (DAT) on the post-transfusion specimen.
- Quarantine additional components prepared from the same donor collection.
- Report findings to transfusion service supervisor or medical director.
A transfusion reaction that happens when patient is not capable of accomodating the volume of the transfused product
TACO
Dyspnea occurs within 24 hrs after transfusion and all other diagnoses are excluded
TAD
NHSN
- adults - drop in systolic BP of ≥30 mmHg and systolic BP ≤80 mmHg
- children - 25% drop in the baseline systolic BP
Hypotensive Transfusion Reaction
nonspecific sign, seen alone during or within 1 hr after transfusion is finished
hypotensive transfusion reaction
The collection of information on the complications of transfusion, analysis of these data, and subsequent data-driven improvements in transfusion practices.
Hemovigilance
manifests as an increase in the body temperature of a recepient of 1C or more that is associated with transfusion
usually caused by anti-leukocyte antibodies against donor unit
FNHTR
How should you prevent FNHTR?
use leukoreduced or leukopoor red blood cells
what is used as treatment for FNHTR?
antipyretics
fever greather than 100.4F (38C) or a change of at least 1.8F (1.0C) from the pretransfusion level occurring during or within 4 hrs after end of the transfusion or chills and/or rigors are present
FNHTR
Prevention of ATRs
- administration of anti-histamine
- washed red blood products
Differential Diagnosis of ATRs
- If respiratory symptoms are prominent, include TRALI and TACO
- If hypotension and/or shock are present, consider AHTRs and TTBIs
Most common reaction seen with platelet and plasma transfusion.
It is second to FNHTR in RBC transfusion.
ATR
Mild to moderate allergic reactions, transient and self-limited; headache, fever, chills, nausea, vomiting, abdominal pain, diarrhea, facial flushing, urticaria, itching, muscular cramps, and back pain are other common symptoms
Adverse Reactions to Infusion of Plasma-Derived Products
Examples of Plasma-Derived Products
- Albumin
- Intravenous immune globulin (IVIG)
- Human-derived factor concentrates
Headache is the most commonly reported symptom
Adverse Reactions to Infusion of Plasma-Derived Products
The appearance of signs and symptoms during or within 2 hours after the end of transfusion and the exclusion of other possible drug, environmental, and dietary causes
ATR
generally mild to moderate reactions and refer to signs and symptoms limited to the skin and gastrointestinal tract.
ATR
The most common manifestations are mucocutaneous reactions, including urticaria, pruritus, and localized or generalized rash. The NHSN Hemovigilance definition includes only anaphylactoid and anaphylactic signs and symptoms.
ATR
A clinical syndrome developing from 2 days to 6 weeks after transfusion characterized by the typical skin rash seen, diarrhea, fever, enlarged liver, elevated liver enzymes, marrow aplasia, and/or pancytopenia
TA-GVHD
Definite diagnosis is made by skin or occasionally liver biopsy showing characteristic histological features
TA-GVHD
HIGH MORTALITY RATE
TA-GVHD
A severe and sudden drop in the platelet count, usually occurring 5 to 10 days after transfusion due to alloimmunization to platelet-specific antibodies from prior transfusion or pregnancy
PTP
1st symptom appears average of 11 days
definite dx: skin/liver biopsies
TA-GVHD
Prevents TA-GVHD
irradiated blood
Thrombocytopenia - less than 20% of the pretransfusion count and demonstration of alloantibodies against platelet specific antigens are required for diagnosis
PTP
1st line of treatment of PTP
IVIG
px respond w/in hrs
PTP patient won’t respond with IVIG
plasma exchange with FFP
Patients have become alloimmunized to HLA (human leukocyte antigen) or platelet-specific antigens
Refractoriness to Platelet Transfusion and Alloimmunization
The chief metabolic effects of transfusion involves citrate toxicity and
hyperkalemia
Adverse Metabolic Effects of Transfusion
True or False
Hypocalcemia is an effect of citrate toxicity
True
During RBC storage, intracellular potassium will slowly leak from the aging RBCs and this may cause increased potassium in the supernatant, leading to
hyperkalemia
Hyperkalemia is very uncommon in massive transfusion in adults, but it is of special concern in
neonatal transfusions
especially in premature infants
Citrate Toxicity: Hypocalcemia or Potassium Toxicity: Hyperkalemia
● Tingling of lips or fingertips
● Twitching or tremors
● Shivering
● Muscle contractions (carpopedal
spasms involving hands or feet)
● EKG abnormalities: prolonged
QT interval
Citrate Toxicity: Hypocalcemia
Citrate Toxicity: Hypocalcemia or Potassium Toxicity: Hyperkalemia
● Muscular weakness
● Absent bowel sounds (‘ileus’)
● EKG abnormalities: peaking of T
waves, prolonged P-R interval
● Ventricular fibrillation
● Cardiac arrest
Potassium Toxicity: Hyperkalemia
Biochemical and morphological changes occur when blood is stored.
This will affect the red cell viability and function. These changes are termed as
RBC storage lesion
Most frequent infection associated with transfusion
TTBI
Laboratory evidence of the pathogen in the recipient and demonstration of the pathogen in at least one or more of the following:
○ Transfused component
○ Donor at the time of collection
○ An additional component prepared from the same donation
○ An additional recipient of a component from the same
donation
TTBI
The predominant bacteria associated with contamination of RBC
Gram-negative rods in the family of Enterobacteriaceae
The predominant bacteria associated with contamination of platelets
Gram-positive cocci usually from the normal skin flora introduced to the product during venipuncture
accounts for the greatest number of deaths due to blood product contamination
Staphylococcus aureus
platelets
Associated with PLATELETS OR RBCs?
Enterobacter cloacae
Escherichia coli
Klebsiella oxytoca
Klebsiella pneumonia
Pseudomonas aeruginosa
Serratia marcescens
RBCs
Associated with PLATELETS OR RBCs?
Staphylococcus aureus
Staphylococcus epidermidis
Staphylococcus lugdunensis
platelets
What will you do if you encounter transfusion reactions?
- The first step is to IMMEDIATELY STOP the transfusion if the infusion is still in process
- The next step is to follow the standard procedure to send appropriate specimen to the laboratory for a transfusion reaction investigation
