Adverse transfusion reactions Flashcards
Discuss the (a) characteristics, (b) causative antibodies, and (c) laboratory investigation of delayed haemolytic transfusion reactions
a) haemolysis occurring >24hrs after transfusion => extravascular haemolysis in reticuloendothelial Sys.; not fatal, [Hb] not rise expectedly, fever, jaundice
b) Missed Ab bc titre dec.: Anti-Jka, Rh, Kell, Duffy Ab
c) DAT +ve -> Ab ID, Spherocytes, inc. bilirubin
Discuss the (a) characteristics, (b) cause, and (c) prevention of TRALI (Transfusion-related Acute lung injury)
a) Sypmtoms begin 2-6hrs after transfusion => Fever, hypotension hypoxemia -> respiratory failure = death
b) Ab in donor plasma bind to HLA/HNA on recipients granulocytes -> (WBC) activated => inc. permeability in pulmonary circ. => pulmonary edema
c) - plasma only collected from males OR females never been prego. OR if prego., test for Anti-HNA/HLA Ab (-ve = safe to transfuse)
Compare and contrast TRALI and TACO
TRALI: symptoms begin 2-6hrs after transfusion
TACO: symptoms begin 1-2hrs after transfusion
Discuss the (a) causes and (b) prevention of transfusion-transmitted infections
a) Viral, parasitic, Bacterial from donor (skin or bacteremia) OR contamination during separation (like water bath)
b) Diversion pouch- remove first 30mL to discard bipsy of skin taken; Plt cultured in 24hrs after manufacturing
Explain why platelet transfusion is the leading cause of transfusion-transmitted bacterial infections
Plt kept @ room temp = favourable environment for bacteria to grow
Discuss the steps taken in the laboratory in the investigation of a transfusion reaction
- Stop transfusion immediately & initiate appropriate therapy
- Monitor vitals
- Maintain IV access
- Check AGAIN that the correct unit was given
- If bacterial/viral rxn suspected => contact ARCLB
- Send to the lab: investigation report; remainder of component being transfused; post-transfusion blood sample; Final post-transfusion urine sample
Adverse donation events
- Vasovagal: dec. BP bc dec. BVol
- Haematoma: bruise
- Nerve irritation/arm pain
- Allergy (to disinfectant)
- Fe deficiency
- Apheresis
• Citrate toxicity
• Haemolysis
• Transfusion transmitted disease (not cleaned properly)
• Air bubble embolism
• depletion of clotting factors (if regular donation)
Discuss the (a) characteristics, (b) cause and (c) symptoms of acute haemolytic transfusion rxn
a) min. to hrs after transfusion starts. Bc complement-mediated intravascular haemolysis (IgM)
b) ABO incompatibilities
c) Inc. HR; chest pain; hyperbilirubinemia
Discuss the (a) characteristics, (b) cause of delayed allergic transfusion rxn
a) urticaria (hives, respiratory distress, can be fatal
b) due to:
- hypersensitivity to allergens or plasma proteins in donor unit
- IgA deficient patients have anti-IgA Ab
Discuss the (a) characteristics, (b) treatment, and (c) prevention of TACO (Transfusion-associated circulatory overload)
a) Dyspnoea, tachycardia, pulmonary odema, hypertension w/in 1-2hrs of transfusion
b) O2, diuretics
c) administer transfusion slowly
Discuss the (a) pathophysiology, (b) treatment, and (c) prevention of Febrile Non-haemolytic transfusion rxn (FNHTR)
a) cytokine released from donor leukocytes bc anti-HLA/HNA Ab in recipient plasma binds & activates donor’s leukocytes
b) acetaminophen (panadol)
c) leukodepletion => remove WBC
Discuss the (a) pathophysiology, (b) results of Transfusion-associated graft vs Host disease (TA-GvHD)
a) transfused immunocompetent (works) T cells in donor proliferate in immunocompromised recipient BM. -> recipient HLA II presented to donor’s T cells & activated => cytokine release & cytolytic activity
b) bone marrow aplasia => fatal
What tests must be done when there is an adverse transfusion reaction? (in ANZSBT guideline)
- inspect transfused units
- check for haemoglobinemia & haemoglobinuria
- ABO/Rh(D) group, Ab screen, DAT on pre- & post- transfusion samples
- ABO/Rh(D) on remaining transfused RBC, rvs gp of plasma
- IAT X-match of recipients pre- & post- transfusion plasma vs transfused RBC
- HLA/HPA/HNA Ab testing - look @ TRALI
- IgA levels (if deficient = hypersensitivity)
- Brain Natriuretic Peptide (BNP): Low in TRALI but High in TACO
