Adverse Effects of Transfusions Flashcards
What are the top three reactions related to transfusion associated mortality?
TRALI, TACO, hemolytic transfusion rxns
Acute hemolytic transfusion reaction is usually due to?
Clerical error involving ABO system
What is the most common symptom of acute intravascular hemolytic transfusion rxn?
Fever is main symptom
What adverse transfusion reaction would you see hemoglobinemia, hemoglobinuria, hyperbilirubinemia, and kidney failure?
Acute intravasular hemolytic transfusion rxn
What is responsible for acute intravascular hemolytic transfusion reaction?
ABO incompatibility
What is the cause of extravascular delayed hemolytic transfusion reactions?
Usually due to clinically significant antibodies such as Rh, Kell, Kidd, and Duffy.
For a hemolytic transfusion rxn to be considered acute, when must it occur?
immediate or within 24 hours
For a hemolytic transfusion rxn to be considered delayed, when must it occur?
hours to days after transfusion
What is a key characteristic of an transfusion reaction that is delayed?
** Positive DAT **
What antibodies commonly cause delayed transfusion rxns?
Kidd antibodies
What is TRALI?
Transfusion related acute lung injury
Acute respiratory problems and bilateral pulmonary edema by xray without cardiac failure
What are the symptoms of TRALI?
Fever, chills, hypotension
What lab values would accompany TRALI?
Transient neutropenia or leukopenia
What causes TRALI?
antibodies in the DONOR that is directed towards neutrophils of HLA antigens
What blood products should be used to prevent TRALI?
Whole blood/plasma from males or never-pregnant females
Or a women who has been tested and negative for HLA antibodies
Why should whole blood or plasma from pregnant or once-pregnant females not be used for transfusion?
Due to risk of TRALI.
Pregnant women can potentially exposed to fetus’ paternally-inherited HLA antigens and can then potentially make antibodies against it.
What is TACO?
Transfusion associated circulatory overload
Pulmonary edema with hypertension caused by VOLUME OVERLOAD.
Who is most at-risk for TACO?
Individuals 70 years old or older
Those who are transfused with large amounts of fluid
What is Febrile Nonhemolytic reaction? (FNH)
** 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
What can prevent Febrile Nonhemolytic reaction?
Leukocyte reduced blood components
What is an allergic reaction in regards to blood transfusion?
An allergic reaction due to IgE formed towards donor plasma proteins
Can be mild or severe.
In mild allergic reaction, what should be done?
Mild - hives with itching
Give antihistamines and continue transfusion
In severe allergic reaction, what should be done?
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
What is the most common cause of transfusion-related death in the United States?
TRALI
What type of lab findings would you find in delayed intravascular/extravascular transfusion reactions?
Increase bilirubin, mixed field DAT, decreased haptoglobin, hgb, hct
Positive antibody screen
