Adverse Effects of Transfusions

Question 1

What are the top three reactions related to transfusion associated mortality?

Answer 1

TRALI, TACO, hemolytic transfusion rxns

Question 2

Acute hemolytic transfusion reaction is usually due to?

Answer 2

Clerical error involving ABO system

Question 3

What is the most common symptom of acute intravascular hemolytic transfusion rxn?

Answer 3

Fever is main symptom

Question 4

What adverse transfusion reaction would you see hemoglobinemia, hemoglobinuria, hyperbilirubinemia, and kidney failure?

Answer 4

Acute intravasular hemolytic transfusion rxn

Question 5

What is responsible for acute intravascular hemolytic transfusion reaction?

Answer 5

ABO incompatibility

Question 6

What is the cause of extravascular delayed hemolytic transfusion reactions?

Answer 6

Usually due to clinically significant antibodies such as Rh, Kell, Kidd, and Duffy.

Question 7

For a hemolytic transfusion rxn to be considered acute, when must it occur?

Answer 7

immediate or within 24 hours

Question 8

For a hemolytic transfusion rxn to be considered delayed, when must it occur?

Answer 8

hours to days after transfusion

Question 9

What is a key characteristic of an transfusion reaction that is delayed?

Answer 9

** Positive DAT **

Question 10

What antibodies commonly cause delayed transfusion rxns?

Answer 10

Kidd antibodies

Question 11

What is TRALI?

Answer 11

Transfusion related acute lung injury

Acute respiratory problems and bilateral pulmonary edema by xray without cardiac failure

Question 12

What are the symptoms of TRALI?

Answer 12

Fever, chills, hypotension

Question 13

What lab values would accompany TRALI?

Answer 13

Transient neutropenia or leukopenia

Question 14

What causes TRALI?

Answer 14

antibodies in the DONOR that is directed towards neutrophils of HLA antigens

Question 15

What blood products should be used to prevent TRALI?

Answer 15

Whole blood/plasma from males or never-pregnant females

Or a women who has been tested and negative for HLA antibodies

Question 16

Why should whole blood or plasma from pregnant or once-pregnant females not be used for transfusion?

Answer 16

Due to risk of TRALI.

Pregnant women can potentially exposed to fetus’ paternally-inherited HLA antigens and can then potentially make antibodies against it.

Question 17

What is TACO?

Answer 17

Transfusion associated circulatory overload

Pulmonary edema with hypertension caused by VOLUME OVERLOAD.

Question 18

Who is most at-risk for TACO?

Answer 18

Individuals 70 years old or older

Those who are transfused with large amounts of fluid

Question 19

What is Febrile Nonhemolytic reaction? (FNH)

Answer 19

** Temperature rise of greater than or equal to > 1C **

Due to leukocyte antibodies to lymphocytes, granulocytes, or platelets
OR
infusion of cytokines in donor bag that build up during storage

Question 20

What can prevent Febrile Nonhemolytic reaction?

Answer 20

Leukocyte reduced blood components

Question 21

What is an allergic reaction in regards to blood transfusion?

Answer 21

An allergic reaction due to IgE formed towards donor plasma proteins

Can be mild or severe.

Question 22

In mild allergic reaction, what should be done?

Answer 22

Mild - hives with itching

Give antihistamines and continue transfusion

Question 23

In severe allergic reaction, what should be done?

Answer 23

Severe - anaphylaxis, hypotension, shock, sometimes death

• IgA deficient patient who have Anti-IgA in their serum is reacting with IgA found naturally in donor plasma*

Prior to transfusion, need to wash cells to remove IgA in serum. Or give cells/plasma from IgA deficient donors

Question 24

What is the most common cause of transfusion-related death in the United States?

Answer 24

TRALI

Question 25

What type of lab findings would you find in delayed intravascular/extravascular transfusion reactions?

Answer 25

Increase bilirubin, mixed field DAT, decreased haptoglobin, hgb, hct
Positive antibody screen