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Heme > Adverse Transfusion Reactions > Flashcards

Adverse Transfusion Reactions Flashcards

1
Q

Why is there a risk for viral transfusion transmission of HIV and hepatitis C even though the donor blood is tested?

A

If donation occurred during the window period of the infection, the viral load would be below the detection limit

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2
Q

Why should you stop a transfusion immediately when a transfusion reaction is expected?

A

The volume of blood transferred is positively correlated with mortality

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3
Q

What are the three types of acute febrile transfusion reactions?

A

Acute hemolytic transfusion reaction (AHTR), febrile non-hemolytic transfusion reaction (FNHTR), and septic reaction due to bacterial contamination

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4
Q

What is the diagnostic criteria for an acute febrile transfusion reaction?

A

Body temperature is >1ºC over baseline or chills/rigors are present

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5
Q

Which of the acute febrile transfusion reactions is benign?

A

FNHTR

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6
Q

What is the mechanism of AHTR?

A

Patient preformed antibodies activate compliment and cause intravascular hemolysis of donor RBCs

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7
Q

What is the most common cause of AHTR?

A

Clerical mistakes leading to transfusion of ABO incompatible blood (blood administered to the wrong patient, wrong identification of blood specimen)

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8
Q

What are the classic symptoms of AHTR?

A

Fever with or without chills, DIC, hypotension, gross hemoglobinuria, renal failure, pain at infusion site or back/flank

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9
Q

Which adverse transfusion reaction classically presents with fever, DIC, hypotension, and renal failure?

A

AHTR

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10
Q

What lab abnormalities would you see with AHTR?

A

Postitive Coomb’s; decreased haptoglobin; increased LDH and indirect bilirubin; positive urine hemoglobin

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11
Q

What adverse transfusion reaction is most likely in a patient with a positive Coomb’s test, decreased haptoglobin, increased LDH and indirect bilirubin, and positive urine hemoglobin?

A

AHTR

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12
Q

Which blood product is most likely to cause a septic reaction?

A

Platelets due to room temperature storage

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13
Q

What pathogens are usually found in contaminated platelets?

A

Gram positive bacteria (staph/strep, etc.)

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14
Q

What pathogens are usually found in contaminated RBC products?

A

Gram negative bacteria

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15
Q

Is bacterial contamination more likely in platelets or RBC transfusion products?

A

Platelets

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16
Q

Which contaminated blood product causes more serious septic reactions?

A

RBC products

17
Q

What are the classic symptoms of a septic transfusion reaction?

A

High fever that does not respond to anti-pyretics, rigor/chills, hypotension, tachycardia, nausea/vomiting, shortness of breath, DIC

18
Q

Which adverse transfusion reaction commonly presents with a high fever that does not respond to anti-pyretics, rigor/chills, hypotension, tachycardia, nausea/vomiting, shortness of breath, and DIC?

A

Septic transfusion reaction

19
Q

What lab abnormalities would you see in a septic transfusion reaction?

A

Positive bacteria culture in remainder of transfused blood product with or without positive recipient blood culture, negative Coomb’s, evidence of DIC

20
Q

What is the most likely proposed mechanism of FNHTR?

A

WBCs in donor blood initiate inflammatory response

21
Q

What is the most common adverse febrile transfusion reaction?

A

FNHTR

22
Q

What are the classic symptoms of FNHTR?

A

Fever during or soon after transfusion with or without chills

23
Q

What are the symptoms of a mild allergic transfusion reaction?

A

Cutaneous symptoms only (urticaria, rash)

24
Q

What are the classic symptoms of an anaphylactic transfusion reaction?

A

Angioedima, bronchospasm/SOB/wheezing, GI symptoms, hypotension, cardiovascular collapse

25
Q

What condition increases the risk of an anaphylactic transfusion reaction?

A

IgA deficiency

26
Q

What is the most common mechanism of anaphylactic transfusion reactions?

A

Patient has preformed antibodies to donor serum proteins (peanut, shellfish, etc.)

27
Q

IgA deficiency increases the risk of what adverse transfusion reaction?

A

Anaphylactic transfusion reaction

28
Q

What are the three types of acute dyspneic transfusion reactions?

A

Anaphylaxis, transfusion-related acute lung injury (TRALI), transfusion associated circulatory overload (TACO)

29
Q

What is the mechanism of TACO?

A

Rapid and/or massive infusion of blood products results in acute pulmonary edema

30
Q

What are the classic symptoms of TACO?

A

Dyspnea, cough, tachycardia, hypertension, crackles in lung bases, elevated CVP/pulmonary artery wedge pressure, severe headache

31
Q

What adverse transfusion reaction commonly presents with dyspnea, cough, tachycardia, and hypertension?

A

TACO

32
Q

What are the risk factors for TACO?

A

Elderly and small children, liver/renal failure, positive fluid balance, severe compensated anemia (thalassemia, SCD, etc.)

33
Q

What is the leading cause of transfusion-related mortality?

A

TRALI

34
Q

What blood products are most likely to induce TRALI?

A

Plasma-containing blood products

35
Q

What are the classic symptoms of TRALI?

A

Hypotension, dyspnea/cyanosis, frothy fluid from ET tube, bilateral “white out” on chest x-ray

36
Q

What adverse transfusion reaction commonly presents with hypotension and dyspnea/cyanosis?

A

TRALI

37
Q

What is the mechanism of TRALI?

A

Donor anti-leukocyte antibodies bind to recipient leukocytes, complex localizes to lungs and releases cytokines and free oxygen radicals

38
Q

What are the three delayed transfusion reactions?

A

Delayed hemolytic transfusion reaction (DHTR), post-transfusion purpura (PTP), transfusion associated graft versus host disease (TA-GVHD)

39
Q

How do we treat blood products to prevent TA-GVHD?

A

Irradiation blasphemoy

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