BLOOD TRANSFUSION REACTIONS Flashcards by Armani Yulong

Many of the ___ events seen with transfusion
are related to the fact that transfusion is the
introduction of ____ into the recipient.

adverse
foreign cells

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___ and ___ involve the introduction of foreign proteins into the recipient that may cause a transfusion reaction

Non-cellular plasma and plasma-derived products

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It also carries the risk of ___

transfusion-transmitted infection

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AABB Requirements for Laboratory Investigation of a Transfusion Reaction
1. ____ of the component bag, label, paperwork, and pre-transfusion patient specimen.
2. ____ ABO testing on the post-transfusion sample.
3. ____ of the pre- and post-transfusion
specimens for hemolysis.
4. ____ on the post-transfusion specimen.
5. ____ additional components prepared from the same donor collection.
6. ____ findings to transfusion service supervisor or medical director

Clerical check
Repeat
Visual check
Direct antiglobulin test (DAT)
Quarantine
Report

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Depends on the onset of signs and symptoms of the individual

Immediate or Delayed type

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In Immediate or Delayed type
- Acute/Immediate: reaction is seen within ____
- Delayed Type: ____ before the
manifestation of transfusion reaction

24 hours
24 hours to 14 days

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Laboratory Tests Confirming Hemolysis in Hemolytic or Non-Hemolytic
1. ____ fibrinogen
2. ___ or ___ haptoglobin
3. ____ bilirubin
4. ____ lactate dehydrogenase
5. Hemoglobinemia/Hemoglobinuria
6. ____ of Spherocyte
7. ____ hemoglobin and hematocrit level on the post-transfusion blood

Decreased
Decreased or absent
Elevated
Elevated
Presence
Low

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Serologic Evidence of Immune-Mediated HTR in Hemolytic or Non-Hemolytic
Cell mediator is present to trigger hemolysis
1. ___ DAT
2. ___ elution with identification of one or more alloantibodies

Positive
Positive

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Nonimmune Hemolysis that is incompatible fluid alongside improper deglycerolization

Osmotic

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Nonimmune Hemolysis that is a malfunction in the water bath or blood warmer; improper storage

Thermal

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Nonimmune Hemolysis that is a problem in blood bag, very small needle during transfusion, artificial heart valves

Mechanical

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Nonimmune Hemolysis that is a caused by sickle cell disease, and Hb C disease

Hemoglobinopathies

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Nonimmune Hemolysis that is associated with G6PD, Hereditary spherocytosis

RBC Membrane and Enzyme Disorders

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Nonimmune Hemolysis is a associated with microangiopathic hemolytic anemia and Hemolytic uremic syndrome

Thrombotic Thrombocytopenic Purpura

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Nonimmune Hemolysis that cause sepsis (CMB)

Clostridium (B), Malaria (P), and Babesia (P)

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Deglycerolization is important ____ transfusion.
Glycerol is just a cryoprotective agent to make sure that the blood won’t be ____ when storing in a low temperature.

before
damaged

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Most severe and most life threatening
A very small amount (at least 10cc) of an incompatible sample could lead to fatal (fetal??) sequelae

Acute, Immunologic Transfusion Reactions

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The associated hemolysis is intravascular

Acute/Immediate Hemolytic Reactions

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Mediators for Immediate Immune Type: (IC)

IgM antibodies (due to incompatible blood type)
Complement

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Signs and Symptoms Acute/Immediate Hemolytic Reactions: Onset of signs and symptoms happen within 24 hours (FCHDHSW)

Fever
Chills
Hemoglobinuria
Dyspnea
Hypotension
Systemic Vascular S/S
Worst/Severe Complication

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Increase temperature of greater than 1ºC after transfusion
Most common type of transfusion reactions
The patient develop fevers

Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

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In FNHTR, ____ caused by interactions of recipient antibodies against the human leukocyte antigens on donor components (WBCs or Platelets)

Mild immunologic reactions

Most common S/S of FNHTR

Fever accompanied by chills

FNHTR Management/Prevention: (LLA)

Use of leukocyte filters
Use of leukocyte reduced components
Administer anti-pyretics

- Second most common type of transfusion reactions - IgE Mediated Transfusion Reaction

Allergic Transfusion Reaction

Allergic Transfusion Reaction Signs and Symptoms: (HEA)

- Presence of hives/urticarial - Erythema - Anaphylactic shock

Allergic Transfusion Reaction Management/ Prevention:

Anti-histamine (administered before transfusion)

Mediator: Plasma Proteins, and Antibodies to IgA antibodies

Anaphylactic Transfusion Reaction

Anaphylactic Transfusion Reaction Management/ Prevention:

Transfuse IgA deficient components

- Caused by ENDOTOXIN-producing organisms particularly gram (-) organism - Cold-growing Yersinia enterocolotica - Associated with Pseudomonas, and Escherichia coli - Causes BACTERIAL SEPSIS - common with Yersinia spp. - Most frequent infection alongside FTHNR, but frequently under-recognized/not reported to the blood bank institution

Bacterial Contamination

Bacterial Contamination S/S (FRHTNP)

- High grade fever - Rigor - Hypotension - Tachycardia - Nausea and Vomiting - Pain and Respiratory complaints

Transfusion-transmitted Bacterial Infection that is usually seen in RBC

Gram(-) organisms

Transfusion-transmitted Bacterial Infection that is usually seen in platelet products

Gram (+)ve Staphyloccocus spp.

- Adverse reaction associated with acute respiratory distress - 2nd common cause of transfusion-related death - Common in patients with a condition that is cardiac and/or pulmonary related - May lead to Congestive Heart Failure and Pulmonary Edema - Associated with number of blood products - Both elderly and younger patients are affected

Transfusion-Associated Circulatory Overload (TACO)

- Usually caused by pulmonary edema due to increased intravascular volume due to excessive transfused fluid - Frequently seen 2 hours after the start of transfusion up to 6 hours - good example of iatrogenic (physician-caused) transfusion reaction

Transfusion-Associated Circulatory Overload (TACO)

- Dyspnea, occurring alone or as the predominant symptom, could be seen in allergic reactions, TACO, or TRALI, or could be related to the patient’s underlying condition. - Unknown pathophysiology - It is diagnosed when dyspnea occurs within 24 hours after transfusion and all other diagnoses are excluded

Transfusion-Associated Dyspnea (TAD)

- It is a nonspecific sign that could be seen in a variety of other transfusion reactions or as part of the patient’s underlying condition - It is defined by NHSN criteria in adults as a very low/ drop in systolic ≥30 mmHg, systolic BP of ≤ 80 mmHg

Hypotension

This entity is diagnosed when hypotension is seen alone during or within 1 hour after the transfusion is finished.

Hypotensive Transfusion Reaction

In children, it is defined as a ___ in the baseline of systolic BP

25%

Hypotensive Transfusion Reaction Management: (LA)

- Leukoreduction filters - Angiotensin Convertin Enzyme Inhibitors

- Happens in more than 24 hours - (+) DAT result for 24 hours to 28 days after transfusion - Either there is positive eluate or a newly identified alloantibody in the plasma/serum that indicates hemolysis - Associated hemolysis is generally EXTRAVASCULAR HEMOLYSIS

Delayed Hemolytic Transfusion Reaction (DHTR)

Delayed Hemolytic Transfusion Reaction (DHTR) mediator (IKKD)

IgG Ab to Rh Kell Kidd Duffy Ag

- Most cases appear 7-10 days after transfusion - Sometimes unsuspected to post-surgical patients because post-operative anemia is attributed to other causes. - Furthermore, there is often incomplete laboratory evaluation to substantiate the presence of hemolysis to diagnosis of anemia - The diagnosis for DHTR is left as probable/possible

Delayed Hemolytic Transfusion Reaction (DHTR)

Happens when immunologic competent lymphocytes (donor’s T-lymphocyte) are being transfused to immunocompromised host with pancytopenia, skin rash, and liver dysfunction

Transfusion-Associated Graft vs. Host Disease (TA-GVHD)

Transfusion-Associated Graft vs. Host Disease (TA-GVHD) S/S (FLRD)

- Fever - Liver Problems - Rash - Diarrhea

Transfusion-Associated Graft vs. Host Disease (TA-GVHD) Management/ Prevention

Transfusion of irradiated blood components

- TA-GVHD’s onset is ____ after transfusion - Associated with ____ - Increased rate of _____

2 days to 6 weeks transplantation mortality

Characterized by severe thrombocytopenia (very low platelet count) 1 week after transfusion due to antibody to platelet specific antigen

Post-Transfusion Purpura

Post-Transfusion Purpura is seen in ____ patients that have been sensitized to platelets due to either pregnancy and/or transfusion

older female

Post-Transfusion Purpura happens ____ after transfusion due to alloimmunization to platelet specific antibodies.

5 to 10 days

- Iron deposition in vital organs seen in patients who have RBC abnormalities: Thalassemia and who undergoes massive/chronic transfusion. - Associated with citrate toxicity (increased citrate)

Transfusion-Induced Hemosiderosis (Iron Overload)

- Late manifestation - Hepatitis B, NON-B Hepatitis (HCV), HIV, HTLV-1 (oncogenic retrovirus that causes adult T cell leukemia), CMV, EBV

Transmission of Diseases

blood-borne transmissible diseases (Spirochetes – do not survive at ref temp for 72 hours)

Syphilis

rare occurrence because it is transmitted through fecal-oral route

Hepatitis A