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Immunohematology > Adverse Effects of Blood Transfusions > Flashcards

Adverse Effects of Blood Transfusions Flashcards

1
Q

Errors Associated with Transfusions

A

Patient Misidentification (very common)
Sample Error
Wrong Blood Issued
Transcription Error
Blood Administration Error
Technical Error
Blood Storage Error

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2
Q

Types of Transfusion Reactions

A

Non-hemolytic Reactions
Hemolytic Reactions
- Immediate Intravascular or Extravascular
- Delayed Extravascular

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3
Q

Types of Non-hemolytic Reactions

A

96% of all reactions are non-hemolytic
Febrile
Allergic
Anaphylactic
Circulatory Overload (TACO)
Transfusion Related Acute Lung Injury (TRALI)
Graft vs Host
Transfusion Transmitted Disease

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4
Q

Febrile Reaction

A

Occurs in 1% of transfusions
>1 degree C rise in temperature
Caused by anti-WBC Antibodies

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5
Q

Febrile Symptoms

A

Fever
Chills

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6
Q

Febrile Future

A

Use leukocyte poor products

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7
Q

Allergic Reaction (Type 1)

A

Implicated in 20% of all reactions
Reaction to donor plasma

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8
Q

Allergic Symptoms

A

Itching
Hives
Edema

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9
Q

Allergic Future

A

Use plasma free products
Wash cells prior to giving

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10
Q

Anaphylactic

A

Caused by Allo Anti IgA Antibody

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11
Q

Anaphylactic Symptoms

A

Mild Allergic reaction
Shock
Death

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12
Q

Anaphylactic Future

A

Plasma free products
Donors lacking IgA (request specific from Blood Bank)

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13
Q

Circulatory Overload

A

Transfusion Associated Circulatory Overload (TACO)

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14
Q

Circulatory Overload Symptoms

A

Chest Pain
Dyspnea
Cough
Heart Failure

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15
Q

Circulatory Overload Future

A

Infuse more slowly (increase time 2 to 4 hours)

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16
Q

Transfusion Related Acute Lung Injury

A

Anti WBC Antibodies - cross react with lungs
Damage to Lung Tissue

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17
Q

Transfusion Related Acute Lung Injury Symptoms

A

Chills
Cough
Fever
Respiratory Failure (most significant indicator)

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18
Q

Graft vs Host

A

Significant mortality
3 - 30 days after transfusion
Donor T cells attack immunocompromised patient

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19
Q

Graft vs Host Symptoms

A

Pancytopenia - decrease in all cell lines
Fever
Abnormal Liver function

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20
Q

Graft vs Host Future

A

Irradiated products

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21
Q

Transfusion Transmitted Disease

A

Hepatitis
HIV
HTLV
West Nile
CMV and EB
Malaria
Babesiosis
Chaga’s Disease
Toxoplasmosis
Rocky Mountain Spotted Fever
Syphilis

22
Q

Transfusion Induced Hemosiderosis

A

Iron Overload

23
Q

Post Transfusion Purpura (PTP)

A

Platelet Alloantibodies
Depletion of platelets and Coag factors

24
Q

Post Transfusion Purpura Symptoms

A

Tiny red Pin Points on patient skin

25
Q

Complications Associated with Massive Transfusion

A

Citrate Toxicity - due to level of citrate in units
Hypothermia
Dilutional Thrombocytopenia

26
Q

Hemolytic Transfusion Reactions

A

Up to 4% of all transfusion reactions
Defined by Intravascular vs Extrascular and Immediate vs Delayed

27
Q

Immediate Intravascular Hemolysis

A

Caused by IgM - complement Activating Ab
IgG - Cause immediate hemolysis
ABO Mix-up

28
Q

Immediate Intravascular Hemolysis Symptoms

A

Occurs within minutes to 2 hours
Fever or Chills
Renal Shutdown
DIC
Hemoglobinemia

29
Q

Immediate Intravascular Hemolysis Mortality

A

10%

30
Q

Immediate Intravascular Hemolysis Treatment

A

Support (treat fever/chills)
Stop transfusion

31
Q

Immediate Extravascular Hemolysis

A

Same as Immediate Intravascular Hemolysis

32
Q

Immediate Extravascular Hemolysis Symptoms

A

Fever, Chills
Renal Shutdown
DIC

33
Q

Delayed Extravascular Hemolysis

A

Anamnestic Response or Ab Production (creation of new Ab or titer increase)
1-3 days

34
Q

Delayed Extravascular Hemolysis Antibody Specificity

A

Rh Antibodies
Anti-Jka (most often seen)
Anti-K
Anti-Fya

35
Q

Delayed Extravascular Hemolysis Symptoms

A

3-7 days post transfusion
Hgb and Hct decreased
Mild symptoms
- Fever
- Chills
- Jaundice
- Lack of Energy

36
Q

Delayed Extravascular Hemolysis Treatment

A

Support
Give new cells that are antigen negative for new Ab

37
Q

Physical Damage to Transfused Cells

A

Heat Damage
Physical Damage

38
Q

Heat Damage

A

Blood Warmers
Storage

39
Q

Physical Damage

A

Pumps
Heart Valves
ECMO

40
Q

Microbe Contamination Common Organisms

A

Yersinia enterocolitica
Pseudomonas
E. coli

41
Q

Microbe Contamination Symptoms

A

Rapid Onset
Fever
Chills
DIC
Shock
Death (septicemia)

42
Q

Microbe Contamination Treatment

A

IV Antibiotics
Support

43
Q

Microbe Contamination Prevention

A

Visual Inspection of Units

44
Q

Patient Care Personnel Responsibilities

A

Take Vital Signs
Stop Transfusion
Keep IV Line Open with Saline
Notify Physician and transfusion service
Perform bedside clerical check
DOCUMENT information
Treat patient with antihistamines

45
Q

Laboratory Personnel Responsibilities

A

Perform Clerical Check
Observe pre & post samples for visual hemolysis
Serum/plasma hemoglobin
Gram stain/culture
Perform DAT on post sample (perform on pre if post is pos)
DAT pos: Elution and identify Ab
DAT neg: Elution and identify Ab (may need to concentration Ab)

46
Q

Proceed to Extended Evaluation IF

A

Discrepancy in Clerical Check
Post DAT pos AND pre DAT neg or weaker AND no ABO incompatible units transfused
Visual hemolysis
Post Serum/plasma hemoglobin 20 mg/dl greater than Pre Serum/plasma hemoglobin

47
Q

Extended Evaluation (Perform on Pre and Post Patient Sample)

A

Perform ABO/Rh
IAT - identify Ab if applicable
Crossmatch again

48
Q

Extended Evaluation (Perform on Lab Seg from Donor)

A

ABO/Rh
Ag Type if Ab Identified

49
Q

Extended Evaluation (Additional Testing)

A

Urine Hemoglobin
- Microscopic if Hgb is positive
Serum Bilirubin
- Collect 3-6 hrs post transfusion
Plasma Hemoglobin (increased post vs pre)
Haptoglobin (decreased post vs pre)
Cultures - rule out septicemia

50
Q

Transfusion Reaction Documentation

A

CRITICAL PART OF INVESTIGATION

51
Q

Transfusion Reaction Documents

A

Notification of physician and blood bank director
Reporting of reactions to accrediting agencies
Fatalities - FDA, Center for Biologic Evaluation & Research

52
Q

Notification of Pathologist

A

Discrepant Clerical Check
Positive DAT in post-reaction with pre-reaction DAT negative
No record of transfusion of ABO incompatible plasma
Visually-evident hemolysis confirmed by 2 samples
Serum/Plasma hemoglobin 20 mg/dl higher than pre-sample
Positive Gram stain/culture

Immunohematology (17 decks)

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