Blood Flashcards
How frequently are there transfusion reactions
1:10,000 to 1:50,000
- new data suggest 1:250,000
Acute hemolytic tranfusion reactions
- death rates 25% with < 100 ml transfused and 44% with > 1000 ml tranfused
Are all transufion reaction imemidate
Immediate occur within 24 hrs (acute hemolytic, allergic (mild, anaphylactic, anaphylactoid), febrile nonhemolytic, hypotensive, bacterica contaminated, TRALI, TACO
Delayed 24-3 months latera (GVHD, delated hemolytic, infectious)
Can all blood products cause transufions rxn?
Yes.
Only incompatible RBC cause intravascular hemolytic
Allergic (most common reactions 1-3%) - occur iwth RBC , plasma or platelet
- Usually result from preformed antiboides to plasam proteins
- IgE may mediate allergic rxn and anphylaxis may occur
-Febrile rxn may be procedue by stored leukocytes (IL-1 endogenous pyrogen) or anti-IgA abx by pts who are deficient in IgA
Immediate intravascular hemolytic tranfusion reaction
Destruction of donor RBC release free hemoglobin, elaborates cytokines and chemokines, activates completment, reduces O2 carrying capacity and caused electrolyte imbalances.
-Usually ABO incompatibility –> high IgM (anti A and B) attach to donor RBCs (can be Kell, Duffy, Rh (IgG and doesn’t do completment), Lewis, and Kidd)
-destruction of these cells and activation of completement lead to acute hemolysis
-Attachment of IgM leas to completment activation, cytokine and kine production, thrombin generation, and platelet activation.
- Completment leads to cell ysis and degranulation of mast cells, histamine release, free radical procection
-Macrophages degranulate and release histamine, serotonin, and cytokines and bradykinin –> hypotension and capillary leak
-DIC
Free hemoglobin –> renovasuclar vasocontstirciton and norepi release in response to hypotension makes this work
Extravascular hemolytic rx
Non-ABO groups –> more often Rh incompatibitlity
- No RBC intravascular destruction
- Removed in spleen or liver
- Low grade fever, or hemoglobinemia or hemoglobinuria
Febrile nonhemolytic tranfusion rx
Most comon type of rxn –> donor leukocytes in transufsed blood products (usually RBC or platelets)
- Increase by 1 degree C
- Chilles, cold, rigors
- Alloantibodies against donor leukocytes - cytokines
- Leukoreduction reduced incidence
- -> 12.5% chance of again if previous –> given leukocyte depleted
- Tx with tylenol and NSAIDS
Allergic transfusion rxn
1% of transfusions
- Usually mild (urticara, swelling, rash) –> sometimes anaphylactic or -toid
- Release of histamine due to donor plasma protiens attach to preformed IgE or IgG antibtoids on mast cells in sensitized individuals
- more likely with FFP
- Anaphylactic usually with IgA deficient individuals
- Anaphylatoid is related to how much is tranfused
Hypotensive rxn
SBp or DBP decrease at least 30 mmHg
- Generation of bradykinin –> hypotension and fluid leaking from endothelial activation
- More often in patients taking ACE inhibitors (ACE breaksdown bradykinin)
Bacteria contaminated transfusion
Mild fever or frank sepsis
Usually with a increase in Temp by > 2C
Absence of hemoglobiemia or -uria distinguishes from AIHTR
Higher incidence in platelets due to temp
Psudomonas, enterobacter, and yersinia can grow at cold temps though
-Transfusion of both bacteria and endotoxin and release of proinflammatory cytokines and IL
-Nitric oxide leads to refractory hypotension
TRALI
1: 1000- 1:4500 transfusions
- Leading cause of morbidity and accounts for 47% of deaths from transfusions
- More common with platelets and FFP and more from multiparous women
- Mortality 5-10%
- Noncardiogenic pulmonary edema within 6 hr of transfusion
- BIlateral pulmonary infiltrates –> 70% require intubation
- Lung injury usually transient and resolves in 72-96 hrs
- Two step process: preexsiting condition cause neutrophil priming along pulmonary vasculature –> transfused blood activates the leukocyte and causes cytotoxic granules to be released –> disrupt endothelium
TACO
Rapid admin of blood products
Esp in pts with preexisting heart dz or renal insufficency
-CHF with dyspnea, desat, overload, and JVD, increased CVP, increased PCWP and tachycardia
- Limit transfusion rates to 2-3 ml/kg/hr
Hyperkalemia
Usually if blood products near the end of their shelf life –> up to 45 mEq/L at end of life
Citrate toxicity
Citrate-phosphate-dextrose is the preservative
- Eliminated in liver - large voles of reduced liver perfusion or fuction and hypothermia impair metabolism
- Citrate binds Ca and Mg
- leads to impaired cardiac function and coagulopathy
Delayed hemolytic reaction
3-10 days post-transfusion
- From amnestic response (prior exposure but quiesent abx at time of transfusion –> slowly ramp up)
- RBC taken via spleen
- More often with Rh groups
GVHD
8-10 days post transfusion
- usually with bone marrow transplants
- close human leukocyte antigen haplotype – recipent sees donor leukocyte as own, but donor cells sees recipent as foreign –> attacking recipent and bone marrow
- Death within a few weeks