Blood Transfusion and Transfusion Reactions

Question 1

clinical presentation for BacterialContamination/Sepsis

Answer 1

 Clinical Presentation:
 Fever and chills  Tachycardia, hypotension  Dyspnea  Nausea and vomiting  Disseminated intravascular coagulation

 STOP the transfusion.  Notify blood bank of the problem. Return residual component to
blood bank for testing.  Send blood from patient for bacterial culture.  Provide supportive treatment for hypotension and fever.  START ANTIBIOTICS immediately without waiting for blood
culture results

Question 2

immediate cause of acute hemolytic transfusion reactions

Answer 2

Presence antibodies in the red

cell recipient that are incompatible with the red blood cells that were transfused. Often due to clerical error.

Question 3

clinical presentation of acute hemolytic transfusion reaciton

Answer 3

• red urine
• back pain
• fever and chills
• DIC
• renal failure

Question 4

treatment for acute hemolytic transfusion reactions

Answer 4

• supportive care
• blood pressure support and monitor for hyperkalemia.
• treat any DIC with platelets plasma and cryoprecipitate.

Question 5

clinical presentation of febrile non-hemolytic transfusion reactions

Answer 5

 Clinical Presentation:
 Fever during or soon after transfusion
 May be associated with
 Chills  Rigors  Nausea  Vomiting  Hypotension  Note: Occasionally fever is not present

Question 6

treatment for FNHTR

Answer 6

acetaminophen for fever
consider premedication (acetaminophen and steroids) for patients with repeated FNHTR

• consider washed RBC or platelets.

Question 7

clinical presentation of TRALI

Answer 7

Syndrome of acute respiratory distress with
Hypoxia Bilateral pulmonary edema No evidence of congestive heart failure Hypotension and fever may occur

treatment is supportive

Question 8

mechanism of TRALI

Answer 8

 Some blood donors have antibodies against foreign HLA or
granulocyte proteins (from alloimmunization).  If these HLA or granulocyte antibodies bind to neutrophils in
the recipient, they may induces adhesive molecules (CD11,
CD18) on cell surface. Neutrophils adhere to pulmonary
endothelial cells and enter lungs.  Degranulation of these white cells in lung tissue results in
leakage of fluid into alveoli (pulmonary edema).  Rarely, the recipient has the alloantibody, which binds to
white blood cells from the donor.

Question 9

clinical presentation of TACO

Answer 9

dyspnea, orthopnea, engorged neck veins, and hypertension/tachycardia.

Question 10

treatment and management for TACO

Answer 10

• stop transfusion
• administer diuretics (furosemide)
• supplemental O2
• resume transfusion once stabilized

Prevention:

• pre-medicate with diuretics
• transfuse slowly.

Question 11

clinical presentation of an allergic reaction/anaphylaxis

Answer 11

 Clinical Presentation:
 Begins 1-45 minutes after start
 Cutaneous reaction (hives, flushing)
 Airway obstruction, dyspnea, wheezing, hypoxia
 Acute anxiety
 Hypotension
 Nausea and vomiting

Question 12

treatment for transfusion induced anaphylaxis

Answer 12

• stop transfusion
• diphenhydramine
• epinephrine
• restart transfusion slowly if urticaria involves less than two thirds of body

Question 13

prevention for transfusion induced anaphylaxis

Answer 13

premedication for diphenhydramine and hydrocortisone. washing RBC, or plasma depletion of platelets.

Question 14

reasons behind delayed hemolytic transfusion reactions

Answer 14

 Antibody-mediated
destruction of transfused
RBC 2 days or more after
transfusion
 Recipient sensitization by
prior transfusion or
pregnancy
 Recipient antibody level
below threshold of
detection
 Antibodies usually in the
Rhesus (E, c), Kidd, Kell
and Duffy systems
 Antibodies usually Ig

Question 15

preventing delayed hemolytic transfusion reactions

Answer 15

avoidance of transgusion

• use of autologous blood (not done now)
• personal record card for sensitized donors

Question 16

Clinical Presentation
 Onset after about 10 days
 Fever, rash, diarrhea, liver dysfunction
 Overwhelming infection
 Fatal in over 90% of cases
 Diagnosis by
 Biopsy (skin, liver, bone marrow)  HLA typing of donor and recipient
 Confirmation requires documentation of presence of donorlymphocytes

What could this be?

Answer 16

TA-GVHD occurs when transfused immune-competent cells mount an
immune response to recipient tissues

Graft Vs Host

Question 17

management of GVHD

Answer 17

 Management:
 Supportive care
 Antibiotics
 Largely ineffective
 Immunosuppressive therapy 

 Prevention:
 Irradiated blood products for patients in all risk groups

Question 18

hemolytic markers

Answer 18

bilirubin, lactate dehydrogenase, haptoglobin

Question 19

triad of hemolysis

Answer 19

normocytic anemia
jaundice
splenomegaly in most cases
high reticulocyte count

Question 20

major cross matching

Answer 20

detects the presence of ANTIBODIES. Patient SERUM mixed with DONOR red blood cells to see if there’s agglutination

Question 21

direct Coombs test

Answer 21

patients RBCc are tested to see if there are antibodies BOUND TO RED CELLS

Question 22

indirect Coombs test

Answer 22

Patient plasma is tested to see if there are antibodies FREE in plasma.

Question 23

T/F type O plasma is universal

Answer 23

FALSE. type O RBC have NO antigens, and the plasma has both A and B antibodies. therefore, it’s the most reactive plasma. the universal plasma is AB

Question 24

T/F Type O RBC is universal

Answer 24

true

Question 25

Plasma antibodies in someone who is type A

Answer 25

they have A antigen and thus have B antibodies.