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Blood Bank > Blood Transfusion Reactions > Flashcards

Blood Transfusion Reactions Flashcards

1
Q

AABB Requirements for Laboratory Investigation of a Transfusion Reaction: (6)

A
  1. Clerical check of the component bag, label, paperwork, and pre-transfusion patient specimen.
  2. Repeat ABO testing on the post-transfusion sample.
  3. Visual check of the pre-and post-transfusion specimens for hemolysis.
  4. Direct antiglobulin test (DAT) on the post-transfusion specimen.
  5. Quarantine additional components prepared from the same donor collection.
  6. Report findings to transfusion service supervisor or medical director.
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2
Q

Classification of transfusion reactions: (3)

A
  1. IMMEDIATE OR DELAYED TYPE
  2. HEMOLYTIC OR NON-HEMOLYTIC
  3. IMMUNE OR NON-IMMUNE
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3
Q

This classification of transfusion reaction depends on the onset of signs and symptoms of the individual

A

IMMEDIATE OR DELAYED TYPE

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4
Q

How long does it take before the transfusion reaction manifest?

Immediate:
Delayed:

A

Immediate: 24 hours
Delayed: 24 hours to 14 days

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5
Q

HEMOLYTIC OR NON-HEMOLYTIC:

Laboratory Tests Confirming Hemolysis: (7)

A
  1. Decreased fibrinogen
  2. Decreased or absent haptoglobin
  3. Elevated bilirubin
  4. Elevated lactate dehydrogenase
  5. Hemoglobinemia/Hemoglobinuria
  6. Presence of Spherocyte
  7. Low hemoglobin and hematocrit level on the post-transfusion blood
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6
Q

HEMOLYTIC OR NON-HEMOLYTIC:

Serologic Evidence of Immune-Mediated HTR: (2)

A
  1. Positive DAT
  2. Positive elution with identification of one or more alloantibodies
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7
Q

What triggers hemolysis in serologic related HTR?

A

Cell mediator

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8
Q

Immune Hemolysis: (7)

A
  1. Alloimmune acute/delayed hemolytic transfusion reaction
  2. Autoimmune hemolytic anemia
  3. Cold agglutinin disease
  4. Drug-induced hemolytic anemia
  5. Paroxysmal Cold Hemoglobinuria
  6. Paroxysmal Nocturnal Hemoglobinuria
  7. Intravenous Hemoglobin
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9
Q

Non-immune Hemolysis: (7)

A
  1. Osmotic
  2. Thermal
  3. Mechanical
  4. Hemoglobinopathies
  5. RBC Membrane and Cell Disorders
  6. Thrombotic Thrombocytopenic Purpura
  7. Clostridium, Malaria, and Babesia
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10
Q

Most severe and most life threatening

A

ACUTE, IMMUNOLOGIC TRANSFUSION REACTIONS

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11
Q

In acute, immunologic TR, how much incompatible sample could lead to a fatal sequelae?

A

at least 10 cc

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12
Q

Mediators for immediate immune type: (2)

A
  1. IgM antibodies (due to incompatible blood type)
  2. Complement
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13
Q

Signs and Symptoms of acute immunologic TR: (13)

A
  1. Fever
  2. Chills
  3. Hemoglobinuria
  4. Dyspnea
  5. Hypotension

Systemic Vascular S/S
6. Uncontrollable bleeding
7. Heat sensation
8. Pain
9. Increased heart rate
10. Constricting pain
11. Hyperbilirubinemia

Worst/Severe Complication
12. Disseminated Intravascular Coagulation (DIC)
13. Renal Failure

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14
Q

Transfusion reaction where there is an increase temperature of greater than 1ºC after transfusion

A

Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

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15
Q

Most common type of transfusion reactions

A

Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

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16
Q

Most common signs and symptoms of Febrile Non-Hemolytic Transfusion Reaction (FNHTR):

A

Fever accompanied by chills

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17
Q

What causes Febrile Non-Hemolytic Transfusion Reaction (FNHTR)?

A

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

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18
Q

FNHTR management/prevention: (3)

A
  1. Use of leukocyte filters
  2. Use of leukocyte reduced components
  3. Administer anti-pyretics
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19
Q

Second most common type of transfusion reactions

A

Allergic Transfusion Reaction

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20
Q

Signs and Symptoms of Allergic Transfusion Reaction: (3)

A
  1. Presence of hives/urticarial
  2. Erythema
  3. Anaphylactic shock
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21
Q

Management/Prevention of Allergic Transfusion Reaction

A

Anti-histamine (administered before transfusion)

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22
Q

IgE Mediated Transfusion Reaction

A

Allergic Transfusion Reaction

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23
Q

Mediator of Anaphylactic Transfusion Reaction:

A

Plasma Proteins and antibodies to IgA antibodies

24
Q

Management/Prevention of Anaphylactic Transfusion Reaction:

A

Transfuse IgA deficient components

25
Q

Caused by endotoxin-producing organisms particularly gram (-) organism

A

ACUTE, NON-IMMUNOLOGIC TRANSFUSION
REACTIONS via Bacterial Contamination

26
Q

Most frequent infection alongside FTHNR, but frequently under-recognized/not reported to the blood bank institution

A

Bacterial Contamination

27
Q

Signs and Symptoms of Bacterial Contamination: (6)

A
  1. High grade fever
  2. Rigor
  3. Hypotension
  4. Tachycardia
  5. Nausea and Vomiting
  6. Pain and Respiratory complaints
28
Q

Bacteria usually seen in red blood cells: (7)

A

Gram (-) organisms:
1. Yersinia enterocolitica
2. Enterobacter cloacae
3. Escherichia coli
4. Klebsiella oxytoca
5. Klebsiella pneumoniae
6, Pseudomonas aeruginosa
7. Serratia marcesence

29
Q

Bacteria usually seen in platelet products: (3)

A

Staphyloccocus spp. (Gram (+)ve)

  1. S. aureus
  2. S. epidermidis
  3. S. lugdunensis
30
Q

Adverse reaction associated with acute respiratory distress

A

Transfusion-Associated Circulatory Overload
(TACO)

31
Q

How does TACO occur?

A

Excessive transfused fluid causes increase in intravascular volume which lead to pulmonary edema

32
Q

Duration of manifestation of TACO:

A

Frequently seen 2 hours after the start of transfusion up to 6 hours

33
Q

2nd common cause of transfusion-related death

A

Transfusion-Associated Circulatory Overload (TACO)

34
Q

good example of iatrogenic (physician-caused) transfusion reaction

A

Transfusion-Associated Circulatory Overload (TACO)

35
Q

Features related to TACO:

A
  1. Acute respiratory distress
  2. Elevated Brain Natriuretic Peptide (BNP)
  3. Elevated Central Venous Pressure
  4. Evidence of positive fluid balance
  5. Radiographic evidence of pulmonary edema
36
Q

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.

A

Transfusion-Associated Dyspnea (TAD)

37
Q

Transfusion reaction with unknown pathophysiology

A

Transfusion-Associated Dyspnea (TAD)

38
Q

How is TAD diagnosed?

A

TAD is diagnosed when dyspnea occurs within 24 hours after transfusion and all other diagnoses are excluded

39
Q

a nonspecific sign that could be seen in a variety of other transfusion reactions or as part of the patient’s underlying condition

A

Hypotension

40
Q

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

A

Hypotensive Transfusion Reaction

41
Q

Defined by NHSN criteria in adults as a very low/ drop in systolic ≥30 mmHg, systolic BP of ≤ 80 mmHg

A

Hypotension

42
Q

How is hypotension in children characterized?

A

25% in the baseline of systolic BP

43
Q

Management of Hypotensive Transfusion Reaction:

A

1.Leukoreduction filters

  1. Angiotensin Convertin Enzyme Inhibitors
44
Q

Mediator of Delayed Hemolytic Transfusion Reaction (DHTR)

A

Mediator: IgG Ab to Rh, Kell, Kidd, and Duffy Ag.

45
Q

Happens in more than 24 hours. (+) DAT result for 24 hours to 28 days after transfusion

A

Delayed Hemolytic Transfusion Reaction (DHTR)

46
Q

Associated hemolysis in DHTR

A

Extravascular Hemolysis

47
Q

Characterized by accelerated destruction of the transfused RBC. Very common associated with secondary or anamnestic response

A

Delayed Hemolytic Transfusion Reaction (DHTR)

48
Q

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

A

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

49
Q

Signs and symptoms of TA-GVHD: (4)

A

o Fever
o Liver Problems
o Rash
o Diarrhea

50
Q

Management of TA-GVHD

A

Transfusion of irradiated blood components

51
Q

Onset of TA-GVHD

A

TA-GVHD’s onset is 2 days to 6 weeks after
transfusion

52
Q

Characterized by severe thrombocytopenia 1 week after transfusion due to antibody to platelet specific antigen

A

Post-Transfusion Purpura

53
Q

Iron deposition in vital organs seen in patients who have RBC abnormalities: Thalassemia and who undergoes massive/chronic transfusion

A

Transfusion-Induced Hemosiderosis (Iron Overload)

54
Q

ACUTE, IMMUNOLOGIC TRANSFUSION REACTIONS: (4)

A
  1. Acute/Immediate Hemolytic Reactions
  2. Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
  3. Allergic Transfusion Reaction
  4. Anaphylactic Transfusion Reaction
55
Q

ACUTE, NON-IMMUNOLOGIC TRANSFUSION REACTIONS: (4)

A
  1. Bacterial Contamination
  2. Transfusion-Associated Circulatory Overload (TACO)
  3. Transfusion-Associated Dyspnea (TAD)
  4. Hypotensive Transfusion Reaction
56
Q

DELAYED ADVERSE EFFECTS OF TRANSFUSION (IMMUNOLOGIC): (3)

A
  1. Delayed Hemolytic Transfusion Reaction (DHTR)
  2. Transfusion-Associated Graft vs. Host Disease (TA-GVHD)
  3. Post-Transfusion Purpura
57
Q

DELAYED, ADVERSE EFFECTS OF TRANSFUSION
(NONIMMUNOLOGIC): (2)

A
  1. Transfusion-Induced Hemosiderosis (Iron Overload)
  2. Transmission of Diseases

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