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Haematology (E) > Blood ransfusion 2 > Flashcards

Blood ransfusion 2 Flashcards

1
Q

What adverse reactions to transfusion can occur acutely?

A 
Acute haemolytic (ABO incompatible)
Allergic / anaphylaxis
Infection (bacterial)
Febrile non-haemolytic
Respiratory (transfusion associated circulatory overload, acute lung injury)
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2
Q

What adverse transfusion reactions are delayed?

A 
Delayed haemolytic transfusion reaction (antibodies)
Infection (viral, malaria, vCJD)
TA-GvHD
Post transfusion purpura
Iron overload
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3
Q

What are commonly the first signs of acute reactions?

A

Rise in temperature
Rise in pulse
Fall in BP

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4
Q

List some potential symptoms of acute transfusion reaction

A 
Fever
Rigors
Flushing
Vomiting
Dyspnoea
Pain at transfusion site
Loin pain
Chest pain
Urticaria
Itching
Headache
Collapse
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5
Q

What are the 10 types of transfusion reactions?

A 
Febrile non-haemolytic transfusion reactions
Allergic transfusion reactions
Wrong blood
Bacterial contamination
Anaphylaxis
Respiratory complications of transfusion
Infections
Delayed haemolytic transfusion reactions
Transfusion associated graft versus host disease
Post transfusion purpura
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6
Q

What is febrile non-haemolytic transfusion reaction?

A

During / soon after transfusion of blood or platelets rise in temperature of 1oC, chills, rigors

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7
Q

How do you treat FNHTR?

A

Stop or slow transfusion; may need to treat with paracetamol

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8
Q

What is the cause of FNHTR?

A

White cells can release cytokines during storage

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9
Q

When are allergic transfusion reactions more likely to occur?

A

With plasma transfusion

In recipients with other allergies and atopy

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10
Q

How do allergic transfusion reactions present?

A

Mild urticarial or itchy rash, sometimes with a wheeze

During or after transfusion

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11
Q

How do you treat allergic transfusion reactions?

A

Usually have to stop or slow transfusion

IV antihistamines to treat (and prevent in future if recurrent)

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12
Q

What happens when someone is given the wrong blood?

A

Symptoms and signs of acute intravascular haemolysis (IgM)
Restless, chest/loin pain, fever, vomiting, flushing, collapse, haemoglobinuria
Decrease BP, increase HR (shock), increase temp

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13
Q

How do you treat/manage wrong blood transfusion?

A

Stop transfusion - check patient / component
Take samples for FBC, biochemistry, coagulation
Repeat x-match and DAT
Discuss with haem

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14
Q

How does bacterial contamination in transfusion present?

A

Restless, fever, vomiting, flushing, collapse

Decrease BP, increase HR, increase temp

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15
Q

What happens in bacterial contamination of transfusion?

A

Bacterial growth can cause endotoxin production which causes immediate collapse

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16
Q

How might bacterial contamination of blood products occur?

A

From the donor (low grade GI, dental, skin infection)

Introduced during processing (environmental or skin)

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17
Q

In what products is bacterial contamination most likely to occur?

A

Platelets > red cells > frozen components

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18
Q

What is the shelf life of rbcs?

A

35 days

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19
Q

What do you need to do with rbc that have been out of the fridge for 30mins and won’t be used?

A

Need to go back in fridge for 6 hours

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20
Q

How does blood transfusion anaphylaxis present?

A

Decrease BP, increase HR
Very breathless with wheeze
Often laryngeal and/or facial oedema

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21
Q

What is the mechanism of blood transfusion anaphylaxis?

A

IgE antibodies in patient cause mast cell release of granules & vasoactive substances
Most allergic reactions are not severe but few are e.g. in IgA deficiency

22
Q

What are the types of respiratory complications of transfusion?

A

Transfusion Associated Circulatory Overload (TACO)
Transfusion Related Acute Lung Injury (TRALI)
Transfusion Associated Dyspnoea (TAD)

23
Q

What is the mechanism of transfusion associated circulatory overload (TACO)?

A

Pulmonary oedema / fluid overload
Often lack of attention to fluid balance, especially in cardiac failure, renal impairment, hypo-albuminaemia, those on fluid replacement, very young, very small and very old

24
Q

What are the clinical features of TACO?

A

SoB, decrease SaO2, increase HR, increase BP

25
Q

What is seen on CXR in TACO?

A

Fluid overload

Cardiac failure

26
Q

What are the symptoms of transfusion related acute lung injury?

A

SoB, decrease O2, increase HR, increase BP

27
Q

What are the CXR findings in TRALI?

A

Bilateral pulmonary infiltrates during/within 6hr of transfusion, not due to circulatory overload or other likely causes

28
Q

What is the mechanism in TRALI?

A

Anti-wbc antibodies (HLA or neutrophil abs) in donor
Interact with corresponding ag on patient’s wbc
Aggregates of wbc get stuck in pulmonary capillaries –> release neutrophil proteolytic enzymes and toxic O2 metabolites –> lung damage

29
Q

How can TRALI be prevented?

A

Male donors for plasma and platelets (no pregnancy or transfusion, so no HLA/HNA antibodies)

30
Q

When can infections occur after transfusion?

A

Months or even years

31
Q

Potential transfusion transmitted infections

A

Malaria
Viral infections (HIV 1+2, HEV, HBV, HCV, HTLV 1+2, Parvovirus, CMV, WNV, Zika)
Variant CJD

32
Q

In whom is it important transfusions are CMV negative?

A 
Very immunosuppressed
Pregnant women (foetus) and neonates
33
Q

In whom is it important to give parvovirus negative transfusion and why?

A

Patients with haemolytic anaemias e.g. sickle cell, hereditary spherocytosis as it causes temporary red cell aplasia

34
Q

What causes delayed haemolytic transfusion reaction?

A

1-3% of all patients transfused develop an ‘immune’ antibody to a RBC antigen they lack - allommunisation
If the patient has another transfusion with RBCs expressing the same antigen, antibodies cause RBC destruction - extravascular haemolysis

35
Q

How long does delayed haemolytic transfusion reaction take?

A

5-10 days

36
Q

What are the haemolysis screen results for delayed haemolytic transfusion reaction?

A

Increased: bilirubin, LDH, Retics
Decreased Hb
DAT positive
Haemoglobinuria over few days

37
Q

What happens in Transfusion Associated Graft-Versus-Host Disease (TaGVHD)?

A

Normally patient’s immune system recognises donor’s lymphocytes as ‘foreign’ and destroys them
In susceptible patients (immunosuppressed) these lymphocytes are not destroyed
Lymphocytes recognise patient’s tissue HLA antigens as foreign so attack patient’s gut, liver, skin and bone marrow

38
Q

What are the clinical features of TaGVHD?

A

Severe diarrhoea
Liver failure
Skin desquamation
Bone marrow failure

39
Q

How do we prevent TaGVHD?

A

Irradiate blood components for very immunosuppressed; or patients having HLA matched components

40
Q

What is the time scale of post transfusion purpura?

A

Purpura appears 7-10 days after transfusion of blood or platelets and usually resolves in around 1 to 4 weeks but can cause life threatening bleeding

41
Q

Who is affected by post transfusion purpura?

A

HPA-1a negative patients, previously immunised by pregnancy or transfusion

42
Q

What is the treatment of post transfusion purpura?

A

Infusion of IVIG

43
Q

How can RhD negative people form corresponding antibody?

A

If exposed to antigen i.e. by receiving blood transfusion or in pregnancy by foetal red cells entering mother’s circulation at delivery or during pregnancy

44
Q

What Ig’s can cross the placenta?

A

IgG

45
Q

What are the clinical features of HDFN?

A 
Foetal anaemia (haemolytic)
Haemolytic disease of newborn - anaemia plus high bilirubin which builds up after birth as no longer removed by placenta
46
Q

What is the treatment when a mother already has RhD antibodies?

A

Check if father has the antigen (so baby could inherit it)
Monitor level of antibody (high or rising more likely to affect foetus)
Check ffDNA sample
Monitor foetus for anaemia (MCA doppler US)
Deliver baby early as HDN gets a lot worse in last few weeks of pregnancy

47
Q

What is the prevention of anti-D problems in preganancy?

A

Always transfuse RhD negative females of child bearing potential with RhD negative blood. Can give intra-muscular injection of anti-D immunoglobulin, at times when mother is at risk of a fetomaternal bleed e.g. at delivery

48
Q

What is the mechanism of action of prophylactic anti-D immunoglobulin?

A

RhD positive (fetal) red cells get coated with anti-D Ig and then they get removed by the mother’s reticulo-endothelial system (spleen) before they can sensitise the mother to produce anti-D antibodies

49
Q

When must anti-D injection be given to be effective?

A

Within 72 hours of sensitising event

50
Q

Give examples of sensitising events

A

Spontaneous miscarriage if surgical evaculation needed and therapeutic terminations
Amniocentesis and chorionic villous sampling
Abdominal trauma
External cephalic version
Stillbirth or intrauterine death

51
Q

What are the doses of anti-D?

A

At least 250iu for events before 20weeks

At least 500iu for events after 20 weeks

52
Q

What other antibodies can possibly cause HDN?

A

Anti-c
Anti-Kell
IgG anti-A and anti-B antibodies from Group O mothers

Haematology (E) (14 decks)

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