Adverse Effects of Transfusion Flashcards
hemovigilance according to AABB
collection of information on complications of transfusion, analysis of data, and subsequent data-driven improvement in transfusion practice
main purpose of hemovigilance
improve reporting of transfusion related adverse events
when are transfusion related fatalities reported to FDA?
ASAP with full written report within 7 days of the event
transfusion reaction signs and symptoms
fever 1C, chills, respiratory distress, hyper or hypotension, abdominal/check/flank/back pain, pain at infusion site, skin manifestations, jaundice or hemoglobinuria, nausea or vomiting, abnormal bleeding, oliguria or anuria
2 major groups of transfusion reactions
immediate (acute)
delayed
immediate hemolytic (immunologic) reactions
intravascular hemolytic
extravascular hemolytic
immediate non-hemolytic (immunologic)
febrile allergic anaphylactic TRALI posttransfusion purpura
immediate non-immunologic reactions
bacterial
circulatory overload
hypothermic
usual cause of acute intravascular hemolytic reaction
ABO incompatibility, most often due to clerical error with mislabeling recipient’s pretransfusion sample at collection or failing to match intended recipient with blood product immediately before transfusion
acute intravascular hemolytic reaction clinical symptoms
hypotension fever discomfort or anxiety dyspnea chills facial flushing kidney pain bleeding from incision sites and mucous membranes
treatment for acute intravascular hemolytic reaction
stop transfusion, keep IV line open, give renal and cardiovascular supportive therapy
lab confirmation of acute intravascular hemolytic reaction
positive DAT Hgb in urine elevated LDH elevated bilirubin decreased haptoglobin
how much ABO incompatible blood is required for acute intravascular hemolytic reaction?
as little as 10cc
what causes hemolysis in acute intravascular hemolytic reaction
ABO antibodies of patient destroy donor red cells in circulation; antibody binds complement which hemolyzes red cells directly in bloodstream
what is the key even leading to renal failure/hypotension/shock in acute intravascular hemolytic reaction?
Ag-Ab complexes cause release of vasoactive compounds (bradykinin) that cause vasodilation –> intravascular volume increases, blood pressure bottoms out and decrease in renal diffusion. Body responds with reflexive vasoconstriction to maintain blood pressure. Kidneys starved for blood
what causes acute extravascular hemolytic reaction?
pre-formed IgG antibody in patient
antibody missed or not detected during pre-transfusion testing or antibody identified by antigen positive red cells given
clinical symptoms of acute extravascular hemolytic reaction
fever
chills
clinical treatment of acute extravascular hemolytic reaction
stop transfusion, keep IV line open, give renal and cardiovascular supportive therapy
lab confirmation of acute extravascular hemolytic reaction
positive DAT
elution of antibody
decreased haptoglobin
what causes extravascular hemolysis
IgG antibody (other than ABO) of patient attaches to corresponding antigen on donor red cells; coated red cells are removed from circulation by liver and spleen and are destroyed extravascularly
what does posttransfusion sample look like in extravascular hemolytic reaction?
icteric due to increase in bilirubin
what does posttransfusion sample look like in intravascular hemolytic reaction?
hemolyzed due to hemoglobin release in bloodstream
transfusion reaction due to HLA antibodies in recipient’s serum to HLA antigens on white cells and/or platelets of donor
febrile immediate non-hemolytic
clinical symptoms of febrile immediate non-hemolytic reaction
fever may have mild chills headache nausea nonproductive cough
clinical treatment for febrile reaction
stop transfusion; treatment not required as symptoms go away quickly
lab confirmation of febrile reaction
negative DAT
negative gram stain/culture
prevention of febrile reactions
leukoreduction
onset of febrile reaction
during transfusion or up to 24 hours post transfusion
onset of allergic reaction
during transfusion or up to 24 hours post transfusion
clinical signs of allergic reaction
urticaria with itching
occasional facial swelling
wheezing
no fever
treatment of allergic reaction
stop transfusion; give antihistamines and epinephrine
prevention of allergic reactions
pre-treat with antihistamines
may require washed products
incidence of allergic reactions
1-3%
incidence of febrile reactions
0.1-1% with leukocyte reduction
reaction due to IgA in donor plasma transfused to IgA deficient recipients with anti-IgA, cytokines
anaphylactic
clinical signs of anaphylactic reaction
flushing shock dyspnea hypotension NO fever
treatment of anaphylactic reaction
stop transfusion
treat symptoms
give epinephrine
prevention of anaphylactic reactions
washed RBCs or frozen/deglyced RBCs
washed platelets
products from IgA deficient donors
incidence of anaphylactic reactions
1:20,000-1:50,000
reaction due to white cell (HLA) antibodies in donor plasma reacting with recipient’s granulocytes within 6 hours of tranfusion
TRALI
clinical signs of TRALI
pulmonary edema hypoxemia fever chills flushing dyspnea hypotension
treatment of TRALI
stop transfusion
immediately administer respiratory support
incidence of TRALI
1:5000-1:190,000
reaction due to platelet antibodies, usually associated with HPA-1a antigen
posttransfusion purpura
reaction due to bacterial contamination of blood products
transfusion-associated sepsis
product with highest risk of bacterial contamination
pooled products
clinical signs of transfusion-associated sepsis
fever chills increased pulse hypotension shock
treatment of transfusion-associated sepsis
stop transfusion
give IV antibiotics, treat symptoms
bacteria associated with unclean FFP thawing waterbath
Pseudomonas
bacteria associated with red cell products
Yersinia, Serratia
bacteria associated with platelet products
Staph, Enterobacter
inability of patient’s circulatory system to handle increased fluid volume of transfusion
TACO
clinical symptoms of TACO
dyspnea cough neck vein distension pulmonary congestion edema
clinical treatment of TACO
stop transfusion
keep head of bed elevated, nasal oxygen, diuretics
resolution of TACO
smaller volume transfusions
incidence of TACO
<1%
reaction that can occur after receiving large amounts of cold blood that results in cardiac arrhythmia and cardiac arrest
hypothermic
types of delayed reactions
delayed hemolytic GVHD citrate toxicity transfusion hemosiderosis transmission of disease
reaction due to reactivated production of antibody in response to foreign RBC antigens
delayed hemolytic
what kind of hemolysis associated with delayed hemolytic reactions?
extraascular
clinical signs of delayed hemolytic reaction
mild jaundice
fever
drop in Hct
antibody associated with delayed hemolytic reactions
Kidd
incidence of delayed hemolytic reactions
1:2,500-1:11,000
occurs when immunocompetent donor lymphocytes engraft and multiply in recipient
GVHD
clinical symptoms of GVHD
skin rash, fever, diarrhea, liver failure, bone marrow suppression, death
clinical treatment of GVHD
none
prevention of GVHD
irradiated cellular products
how to decrease citrate toxicity?
calcium administration
increased iron deposits due to long-continued transfusion
transfusion hemosiderosis
diseases associated with transfusion
hepatitis B hepatitis C HIV syphilis CMV malaria
incubation period of hep B
6-26 weeks
most common form of hepatitis occurring with transfusion today
hep C
what products carry increased risk of hep and HIV transmission?
pooled components and plasma derived fractions of lyophilized factor VIII and IX
what percent of blood donors are said to have CMV infectious leukocytes?
6-12%
most common cause of acute hemolytic transfusion reaction
clerical error resulting in wrong ABO type transfused
when is bilirubin most effectively tested after suspected reaction?
6 hour post
most transfusion associated deaths are caused by?
acute hemolysis, anaphylaxis, sepsis, or TRALI
