Adverse outcomes and the hazards of transfusion- amanda Flashcards
Febrile reactions (immediate adverse effects)
Due to wbc antibodies (human leukocyte antigens) by previous sensitisation
Produces rigors, pyrexia and pulmonary infiltrates
More common with platelet transfusions
Leucodepletion reduces this risk
Non-febrile reactions
Due to hypersensitivity to donor plasma proteins such as IgA
Rapid (1-6 hours of transfusions)
Anaphylactic shock occurs
Irregular breathing
Graft versus host disease
Normally presents within first week of transfusion
Fever, abdominal pain, diarrohrea, anorexia
One organ targeted is the skin
Transfusion associated graft versus host disease
-occurs in recipients when immune competent donor T lymphocytes mount an immune response against the recipients lymphoid tissue
-occurs in immunocompromised patients when recipient is unable to mount an immune response towards the donor cells
-HLA disparity between donor and recipient
-donor lymphocytes destroy patient tissue expressing foreign HLA types
-presents with fever, skin rash, gastrointestinal symptoms, liver injury as well as hypoproliferative pancytopenia due to attack on recipient haemopoeitic tissue
TA-GVHD
-bone marrow failure occurs due to attach of the patient bone marrow by donor T lymphocytes
-more frequently occurs when donor is homozygous for a HLA haplotype which the patient is heterozygous therefore patient does not perceive the donor cells as foreign. Donor however perceives the patient cells are foreign and mounts an immune response
-rare condition,symptoms appear with 8-10 days after transfusion but invariably fatal leading to death within 1 month
-avoided by irradiation of all blood and blood components for susceptible individuals
Transfusion related acute lung injury
-may be caused by transfusing any plasma-containing blood product
-caused by interaction between the recipients leukocytes and pre-existing donor anti-leukocyte antibodies
-must occur within first 6 hours of transfusion
-this results in complement activation and increased vascular permeability
Transfusion associated circulatory overload (TACO)
-circulation is overburdened following transfusion, vulnerable individuals would be very young e.g., neonates or elderly
-SHOTcases:incorrect volume given to neonate based on volume per kilo calculation error 15ml/Kg heard as 50ml/Kg during telephone request or elderly woman transfused 5 units of blood due to sampling error close to IV fluid line
-transfusion decision made on incorrect data : info not from current sample or sampling error leading to incorrect interpretation clerical error
Incorrect blood component transfused
Does not mean you get red cells when you should have got platelet!!!
Examples: neonate receiving adult units, child under 16 not receiving pathogen reduced plasma, immune-compromised individual not receiving CMV negative blood
Bacterial contamination
-usually platelets although red cells also implicated
-potential points during process for contamination - inadequate sterilisation of the arm prior to phlebotomy, contaminated blood pack, contamiantion during processing, contamination of FFP port during preparation for transfusion, asymptomatic donor
Preventative measures of bacterial contamination
- standardised arm swab technique
-diversion pouch
-quality control of blood packs
-closed system processing
-bacterial monitoring
Massive transfusion
The replacement of the entire blood volume within a 24-hour period or the replacement of 10 units of blood over the course of a few hours due to major trauma or surgery
Complications of massive transfusion
-coagulopathy caused by a dilutional effect on the hosts clotting factors and platelets, as well as lack of platelets and clotting factors in packed RBCs
-volume overload
-hypothermia
-hyperkalemia may be caused by lysis of stored red cells and is increased in irradiated red blood cells
-metabolic alkalosis and hypocalcemia may be caused by the transfusion of a large amount of citrates cells
-hpocalceima due to citrate toxicity may occur in those with hepatic failure, congestive heart failure CHF, or other low-output states
-it is increasingly uncommon with the use of component therapy.
Donor blood microbiology testing
- HIV (anti-HIV 1 and 2, HIV RNA)
- Hepatitis C (anti-HCV, HCV RNA)
- Hepatitis B
- Hepatitis E
- Syphilis
- Human T cell lymphotropic virus
-Other discretionary tests e.g., CMV, malaria
Window periods for different viruses - serology test
HBV- 36 days
HCV- 65 days
HIV- 15 days for anti-HIV or 11 days for combined antibody/antigen test
HTLV- 45 days
HIV
-transmitted both in cellular. And plasma components of blood
-unfortunate complication following transfusion of FVIII concentrate collected during late 1970s to haemophiliacs
-heat treatment of plasma concentrates now prevents HIV transmisssion
-donor education and encouragement of high-risk groups to exclude themselves from blood donation has been successful
-all blood units taken are tested for anti-HIV by ELISA and HIV NAT
Hepatitis and CMV
-may be due to one of the hepatitis viruses
-post transfusion hepatitis B is seen less frequently now because of routine hepatitis B surface antigen testing
-CMV likely to cause problems in newborn, bone marrow and renal transplant patients
-transfusion of CMV-negative blood products or leucodepleted blood to CMV-negative recipients reduces the risk
Post-transfusion iron overload
-repeated red cell transfusion over many years, in absence of blood loss, cause deposition or iron initially in reticuloendothelial tissue at ann increased rate, resulting in iron toxicity
-after 50 units in adults, the liver, myocardium and endocrine glands are damaged with clinical consequences
- major problem in thalassemia
-linked to free radical damage
Avoiding other transfusion complications
-correct identification of patient and samples
-donor testing, grouping, serology and microbiology testing
-leucodepletion
-universal irradiation of platelets but also other blood components as required
-bacterial monitoring of platelets
-platelet additive solution to re-suspend platelets
-pathogen reduction measures for plasma e.g.,solvent detergent treatment, methylene blue, psoralen treatment
-pathogen reduction for cellular material (FLARE and INACTINE)
-threshold transfusion policy
