BLOOD COMPONENT TRANSFUSION REACTION

Question 1

TYPES OF TRANSFUSION REACTIONS

Answer 1

• Acute TR- occurs within 24 hours post transfusion.
• Delayed TR- develops after 24 hours post transfusion.

Question 2

most severe type of transfusion reactions

Answer 2

Hemolytic Transfusion Reaction

Question 3

Two types of Hemolytic Transfusion Reaction

Answer 3

• Immediate HTR/ Intravascular HTR
• Delayed HTR/ Extravascular HTR

Question 4

• Reaction takes place within the circulatory system.
• Hemolysis occur within few min after starting transfusion (<24 hrs)
• Due to IgM Abs, mediated by the rapid activation of complement and is usually associated with the transfusion of ABO in incompatible blood.

Answer 4

IHTR or Intravascular HTR

Question 5

MANAGEMENT and THERAPY for IHTR or Intravascular HTR

Answer 5

• Stop transfusion immediately.
• Mannitol is the agent used to prevent the renal failure.
• Hypotension: intravenous fluid and vasoactive drugs .e.g. dopamine

Question 6

• rarely severe and mainly due to IgG antibodies, e.g. Rh, kell or Duffy system.
• These ab’s bring about the destruction of red cells by the macrophages in the spleen or liver.
• Hemolysis occur after few hours or after about 3-7 days of transfusion.

Answer 6

Delayed HTR/ Extravascular HTR

Question 7

Delayed HTR/ Extravascular HTR Could be due to

Answer 7

ALLO-IMMUNIZATION or ANAMNESTIC RESPONSE

Question 8

• an immune response to foreign antigens from another human, most commonly occurring after pregnancy or blood transfusions.
• In chronically transfused patients, the risk for them developing antibodies against the red cell antigens (RBC alloimmunization) increases by 2% to 8%.

Answer 8

ALLOIMUNIZATION

Question 9

Any immunological response in which a second or subsequent exposure to an antigen causes a greater and more rapid reaction than that elicited by the initial exposure. It is a manifestation of immunological memory.

Answer 9

ANAMNESTIC RESPONSE

Question 10

SIGNS and SYMPTOMS of Delayed HTR/ Extravascular HTR

Answer 10

• Fall in Hgb
• Rise in bilirubin
• Mild jaundice within 5-7 days post transfusion
• Renal failure (rare)

Question 11

NON HEMOLYTIC TRANSFUSION REACTIONS

Answer 11

• Febrile Non Hemolytic TR (FNHTR)
• Urticarial TR (allergic)
• Anaphylactic TR
• Transfusion- Related Acute Lung Injury (TRALI)
• Transfusion Associated Circulatory Overload (TACO)
• Graft Versus Host Disease (GVHD)

Question 12

• These reactions are the most common and account for over 90 % of TR.
• ↑ temperature, >1 Cͦ
• These are benign, self-limiting reaction due to the presence of ab’s to WBC or PLT antigens and are usually seen in multi transfused patients.
• These occur within minutes of starting the transfusion

Answer 12

Febrile Non Hemolytic TR (FNHTR)

Question 13

SIGNS and SYMPTOMS of Febrile Non Hemolytic TR (FNHTR)

Answer 13

• Fever
• Chills
• Malaise

Question 14

THERAPY and PREVENTION for FNHTR

Answer 14

• give leukocyte poor red cells.
• Anti-pyretic can be given before starting transfusion, but they must be avoided as much as possible as they mask IHTR.

Question 15

LABORATORY INVESTIGATIONS for FNHTR

Answer 15

• No red/pink plasma
• DCT negative
• No increase in bilirubin
• No hemoglobinuria

Question 16

• A type of immediate hypersensitivity reaction.
• Allergic signs and symptoms appear within few minutes of exposure.

Answer 16

URTICARIAL (ALLERGIC) TR

Question 17

• The donor’s plasma contain allergens which react with reagin present in patient’s plasma.
• The donor’s plasma contains reagin that combines with allergens in the patient plasma.

Answer 17

URTICARIAL (ALLERGIC) TR

Question 18

Pathophysiology of URTICARIAL (ALLERGIC) TR

Answer 18

Allergin- Reagin complex ➡️ Attachment to mast cell surface ➡️ Release of HISTAMINE

Question 19

THERAPY and PREVENTION for URTICARIAL TR

Answer 19

Antihistamine

Question 20

• This is a severe, life-threatening reaction, which occur in rare patients who are IgA deficient and have developed anti-IgA ab’s.
• These reaction developed quickly- within minutes of starting the transfusion.

Answer 20

ANAPHYLACTIC TR

Question 21

THERAPY and MANAGEMENT for ANAPHYLACTIC TR

Answer 21

• Keep IV line open with normal saline.
• Inject epinephrine
• Inject antihistaminic
• In cases of Hypoxia- give oxygen by mask

Question 22

Also known as non cardiac pulmonary edema

Answer 22

TRANSFUSION RELATED ACUTE LUNG INJURY
(TRALI)

Question 23

• Altered permeability of the pulmonary capillary bed by activation of complement, histamine mediated events, or prostaglandins which leads to fluid accumulation, inadequate oxygenation, and reduced cardiac return.
• Happens within 6 hours during transfusion
• Pathophysiology is not well established

Answer 23

TRANSFUSION RELATED ACUTE LUNG INJURY
(TRALI)

Question 24

Both the immune and nonimmune of this lead to damaged endothelium, leading to pulmonary capillary permeability and resulting in noncardiogenic pulmonary edema.

Answer 24

TRANSFUSION RELATED ACUTE LUNG INJURY
(TRALI)

Question 25

Types of TRALI

Answer 25

Immune TRALI
Nonimmune TRALI

Question 26

antibody mediated, one-hit event. Antibody against Human Leukocyte Antigen (HLA) or Human Neutrophil Antigen (HNA) react with recipient’s leukocytes, causing aggregates that occlude the pulmonary circulation.

Answer 26

Immune TRALI

Question 27

consists of a two-hit event. The first hit (i.e., lung trauma or an infectious or inflammatory disease in the patient) may result in priming of the patient’s neutrophils. Therefore, a proinflammatory priming event of the patient’s endothelium, which primes the patient’s neutrophils. The second hit (i.e., transfused biologically active substances accumulated during storage or antileukocyte antibodies) causes the activation of the primed neutrophils.

Answer 27

Nonimmune TRALI

Question 28

SIGNS and SYMPTOMS of TRALI

Answer 28

• Acute onset of respiratory distress
• Dyspnea
• Cyanosis
• Fever
• Chill

Question 29

THERAPY and MANAGEMENT for TRALI

Answer 29

• Oxygen therapy
• Intubation
• Intravenous steroids
• Leukocyte poor component is used

Question 30

• Occur with platelet concentrate transfusion.
• Rapid onset of thrombocytopenia due to production of platelet alloantibodies.
• Usually in multiparous female.
• Duration: 7-14 days from transfusion.

Answer 30

POST TRANSFUSION PURPURA (PTP)

Question 31

Therapy for POST TRANSFUSION PURPURA (PTP)

Answer 31

corticosteroids

Question 32

Complication of blood component therapy or bone marrow transplantation.

Answer 32

GRAFT versus HOST DISEASE (GVHD)

Question 33

Patients at risk for GRAFT versus HOST DISEASE (GVHD)

Answer 33

• Lymphopenic patients
• Bone marrow suppressed cases
• Fetus receiving intrauterine transfusion
• Newborn infants receiving exchange transfusion
• Congenital immunodeficiency syndrome

Question 34

THERAPY for GVHD

Answer 34

corticosteroids , prevention.

Question 35

Give the 2 NON IMMUNE, NON HEMOLYTIC TR

Answer 35

• IMMEDIATE: Bacterial overload, Circulatory overload
• DELAYED : Iron overload

Question 36

• an acute nonimmune transfusion reaction presenting with body temperatures usually 2°C or more above normal and rigors that can be accompanied by hypotension.
• occurs when a bacteria-contaminated blood component is transfused.
• Abruptness of presentation may be similar to AHTR

Answer 36

TRANSFUSION- ASSOCIATED SEPSIS (TAS)

Question 37

• More volume of blood transfused
• Cause : fast rate
• Leads to congenital heart failure , pulmonary edema
• Signs: chest pain, cough, hypertension

Answer 37

TRANSFUSION ASSOCIATED CIRCULATORY
OVERLOAD (TACO)

Question 38

• Long term complication of RBC transfusion
• Also known as transfusion haemosiderosis.

Answer 38

IRON OVERLOAD

Question 39

Therapy for IRON OVERLOAD

Answer 39

iron chelating agent.