Blood Transfusion

Question 1

Transfusion Reactions

Discuss the basic patient monitoring during and after blood transfuson

Answer 1

1. Pulse
2. Blood Pressure
3. Temperature
4. Respiratory Rate
5. General Visual Observations
6. General Urinary Observations
7. Verbal Inquirt to the patient’s wellbeing

Question 2

What are the steps to take in case of blood transfusion reaction?

Answer 2

1. Stop the blood transfusion immediately
2. Mantain venous access with normal saline
3. Contact transfusion service for advice
4. venous access must be mantained with CRYSTALLOID SOLUTION
5. Investigations must be done (Blood cultures, Urine Dipstix, EDTA, clotted blood sample.
6. Complete reaction report by SANBS

Question 3

What are the signs and symptoms suggestive of a Transfusion Reaction?

Answer 3

1. Chills
2. Tachycardia/Bradycardia
3. Chest Pain
4. Haemoglobunuria
5. Fever/ Sweating
6. Bronchospasm
7. Nausea/Vommiting
8. Oliguria/ Anuria
9. Jaundice

Blood Transfusion Reactions may be Haemolytic or Non-haemolytic

Question 4

Haemolytic Transfusion Reactions

Describe Immediate Haemolytic Transfusion Reactions and their Effects(symptoms)

Answer 4

They occur Intravascularly.
Usually due to ABO incompatibility
The effects are very rapid (within 15-20 minutes)
1. Fall in blood pressure
2. tachycardia
3. dyspnoea
4. chest and lower back pain
5. burning at the site of infusion
6. fever
7. Haemoglobinuria(leading to a dark brown urine)
8. Decreased Haptoglobin (as a result of haemolysis, prevents iron loss and renal damage)
9. Haemopexin (binds and transnports Haem to the liver)
10. Renal Failure(due to hypotension)
11. End complication is Disseminated Intravascular Coagulation

Question 5

Discuss the cause and effects on delayed haemolytic transfusion reaction.

Answer 5

it is Extravascular

Caused as a result of alloantibodies directed against antibodies of blood group systems other than ABO groups.

Effects/ Symptoms- not as severe
1. Fever
2. Malaise
3. Hyperbilirubinaemia (with JAUNDICE and Urobilinogenuria)

Question 6

NHTR

Describe the possible cause and symptoms of Febrile Non Haemolytic Transfusion Reactions.

there are 5 non-haemolutic transfusion reactions

Answer 6

common in patients requiring multiple transfusions
Symptoms
1. Headache
2. Myalgia
3. nausea
4. chiils
5. rigors
6. FEVER

Causes
no specific cause, but could be
1. FEVER may be due to Human Leukocyte Antigen antibodies reacting with donor lymphocytes
2. could occur in autologous transfusion, and this indicates that it could be caused by storage effects, i.e. againg leukocytes releasing inflammatory cytokines.

Question 7

Describe the causes, symptoms and signs and management of Transfusion Associated Acute Lung Injury (TRALI)

Answer 7

Causes
HLA(lymphocytotoxic) and Leukoagglutinating antibodies present in the plasma of the donor

Signs and Symptoms
1. Hypotension
2. Fever
3. Pulmonary Oedema
4. Dyspnoea
clinically indistinguishable from the Adult Respiratory Distress Syndrome

Management
Mechanical ventilation
Fluid Input to mantain blood pressure and cardiac output

Question 8

Describe the Cause, signs and symptoms of Transfusion Associated Graft versus Host Disease (TA-GvHD)

THIS IS VERY RARE

Answer 8

Cause
Occurs when lymphocytes from a donor who has a homozygous HLA Class One Haplotype ae transfused to a patient possesing the same haplotype but are heterozygous. This allows the host to accept donor lymphocytes as “self” and then engraftment occurs, but after engraftment, donor cells see the recipient tissues/cells as ‘non-self’ and rejection occurs.

Symptoms
1. Florid Maculopapular erythematous rash
2. Fever
3. Jaundice
4. Pancytopenia
5. Profuse watery diarrhoea
there will be aberrations in liver function

**TA-GvHD can be prevented by exposing the blood to 25-30Gy irradiation prior to transfusion.

would occur more when family memebrs donate blood for one another

blood given to immunocompromised indivs. and neonates should be irradiated.

Question 9

Describe the cause and management of Post Transfusion Purpura

Answer 9

Cause

PTP occurs in patients who have previosuly developed alloantibodies against a platelet specific antigen. The platelets of the patient are also destroyed, hence leading to severe thrombocytopenia. This is a sef-limitng disease. It occurs about 9-10 days after transfusion

Managamement
Fresh Frozen Plasma