Adverse Effects of Blood Transfusions Flashcards
Errors Associated with Transfusions
Patient Misidentification (very common)
Sample Error
Wrong Blood Issued
Transcription Error
Blood Administration Error
Technical Error
Blood Storage Error
Types of Transfusion Reactions
Non-hemolytic Reactions
Hemolytic Reactions
- Immediate Intravascular or Extravascular
- Delayed Extravascular
Types of Non-hemolytic Reactions
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
Febrile Reaction
Occurs in 1% of transfusions
>1 degree C rise in temperature
Caused by anti-WBC Antibodies
Febrile Symptoms
Fever
Chills
Febrile Future
Use leukocyte poor products
Allergic Reaction (Type 1)
Implicated in 20% of all reactions
Reaction to donor plasma
Allergic Symptoms
Itching
Hives
Edema
Allergic Future
Use plasma free products
Wash cells prior to giving
Anaphylactic
Caused by Allo Anti IgA Antibody
Anaphylactic Symptoms
Mild Allergic reaction
Shock
Death
Anaphylactic Future
Plasma free products
Donors lacking IgA (request specific from Blood Bank)
Circulatory Overload
Transfusion Associated Circulatory Overload (TACO)
Circulatory Overload Symptoms
Chest Pain
Dyspnea
Cough
Heart Failure
Circulatory Overload Future
Infuse more slowly (increase time 2 to 4 hours)
Transfusion Related Acute Lung Injury
Anti WBC Antibodies - cross react with lungs
Damage to Lung Tissue
Transfusion Related Acute Lung Injury Symptoms
Chills
Cough
Fever
Respiratory Failure (most significant indicator)
Graft vs Host
Significant mortality
3 - 30 days after transfusion
Donor T cells attack immunocompromised patient
Graft vs Host Symptoms
Pancytopenia - decrease in all cell lines
Fever
Abnormal Liver function
Graft vs Host Future
Irradiated products
Transfusion Transmitted Disease
Hepatitis
HIV
HTLV
West Nile
CMV and EB
Malaria
Babesiosis
Chaga’s Disease
Toxoplasmosis
Rocky Mountain Spotted Fever
Syphilis
Transfusion Induced Hemosiderosis
Iron Overload
Post Transfusion Purpura (PTP)
Platelet Alloantibodies
Depletion of platelets and Coag factors
Post Transfusion Purpura Symptoms
Tiny red Pin Points on patient skin
Complications Associated with Massive Transfusion
Citrate Toxicity - due to level of citrate in units
Hypothermia
Dilutional Thrombocytopenia
Hemolytic Transfusion Reactions
Up to 4% of all transfusion reactions
Defined by Intravascular vs Extrascular and Immediate vs Delayed
Immediate Intravascular Hemolysis
Caused by IgM - complement Activating Ab
IgG - Cause immediate hemolysis
ABO Mix-up
Immediate Intravascular Hemolysis Symptoms
Occurs within minutes to 2 hours
Fever or Chills
Renal Shutdown
DIC
Hemoglobinemia
Immediate Intravascular Hemolysis Mortality
10%
Immediate Intravascular Hemolysis Treatment
Support (treat fever/chills)
Stop transfusion
Immediate Extravascular Hemolysis
Same as Immediate Intravascular Hemolysis
Immediate Extravascular Hemolysis Symptoms
Fever, Chills
Renal Shutdown
DIC
Delayed Extravascular Hemolysis
Anamnestic Response or Ab Production (creation of new Ab or titer increase)
1-3 days
Delayed Extravascular Hemolysis Antibody Specificity
Rh Antibodies
Anti-Jka (most often seen)
Anti-K
Anti-Fya
Delayed Extravascular Hemolysis Symptoms
3-7 days post transfusion
Hgb and Hct decreased
Mild symptoms
- Fever
- Chills
- Jaundice
- Lack of Energy
Delayed Extravascular Hemolysis Treatment
Support
Give new cells that are antigen negative for new Ab
Physical Damage to Transfused Cells
Heat Damage
Physical Damage
Heat Damage
Blood Warmers
Storage
Physical Damage
Pumps
Heart Valves
ECMO
Microbe Contamination Common Organisms
Yersinia enterocolitica
Pseudomonas
E. coli
Microbe Contamination Symptoms
Rapid Onset
Fever
Chills
DIC
Shock
Death (septicemia)
Microbe Contamination Treatment
IV Antibiotics
Support
Microbe Contamination Prevention
Visual Inspection of Units
Patient Care Personnel Responsibilities
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
Laboratory Personnel Responsibilities
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)
Proceed to Extended Evaluation IF
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
Extended Evaluation (Perform on Pre and Post Patient Sample)
Perform ABO/Rh
IAT - identify Ab if applicable
Crossmatch again
Extended Evaluation (Perform on Lab Seg from Donor)
ABO/Rh
Ag Type if Ab Identified
Extended Evaluation (Additional Testing)
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
Transfusion Reaction Documentation
CRITICAL PART OF INVESTIGATION
Transfusion Reaction Documents
Notification of physician and blood bank director
Reporting of reactions to accrediting agencies
Fatalities - FDA, Center for Biologic Evaluation & Research
Notification of Pathologist
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
