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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
Caused by endotoxin-producing organisms particularly gram (-) organism
ACUTE, NON-IMMUNOLOGIC TRANSFUSION REACTIONS via Bacterial Contamination
26
Most frequent infection alongside FTHNR, but frequently under-recognized/not reported to the blood bank institution
Bacterial Contamination
27
Signs and Symptoms of Bacterial Contamination: (6)
1. High grade fever 2. Rigor 3. Hypotension 4. Tachycardia 5. Nausea and Vomiting 6. Pain and Respiratory complaints
28
Bacteria usually seen in red blood cells: (7)
Gram (-) organisms: 1. Yersinia enterocolitica 2. Enterobacter cloacae 3. Escherichia coli 4. Klebsiella oxytoca 5. Klebsiella pneumoniae 6, Pseudomonas aeruginosa 7. Serratia marcesence
29
Bacteria usually seen in platelet products: (3)
Staphyloccocus spp. (Gram (+)ve) 1. S. aureus 2. S. epidermidis 3. S. lugdunensis
30
Adverse reaction associated with acute respiratory distress
Transfusion-Associated Circulatory Overload (TACO)
31
How does TACO occur?
Excessive transfused fluid causes increase in intravascular volume which lead to pulmonary edema
32
Duration of manifestation of TACO:
Frequently seen 2 hours after the start of transfusion up to 6 hours
33
2nd common cause of transfusion-related death
Transfusion-Associated Circulatory Overload (TACO)
34
good example of iatrogenic (physician-caused) transfusion reaction
Transfusion-Associated Circulatory Overload (TACO)
35
Features related to TACO:
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
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.
Transfusion-Associated Dyspnea (TAD)
37
Transfusion reaction with unknown pathophysiology
Transfusion-Associated Dyspnea (TAD)
38
How is TAD diagnosed?
TAD is diagnosed when dyspnea occurs within 24 hours after transfusion and all other diagnoses are excluded
39
a nonspecific sign that could be seen in a variety of other transfusion reactions or as part of the patient’s underlying condition
Hypotension
40
This entity is diagnosed when hypotension is seen alone during or within 1 hour after the transfusion is finished
Hypotensive Transfusion Reaction
41
Defined by NHSN criteria in adults as a very low/ drop in systolic ≥30 mmHg, systolic BP of ≤ 80 mmHg
Hypotension
42
How is hypotension in children characterized?
25% in the baseline of systolic BP
43
Management of Hypotensive Transfusion Reaction:
1.Leukoreduction filters 2. Angiotensin Convertin Enzyme Inhibitors
44
Mediator of Delayed Hemolytic Transfusion Reaction (DHTR)
Mediator: IgG Ab to Rh, Kell, Kidd, and Duffy Ag.
45
Happens in more than 24 hours. (+) DAT result for 24 hours to 28 days after transfusion
Delayed Hemolytic Transfusion Reaction (DHTR)
46
Associated hemolysis in DHTR
Extravascular Hemolysis
47
Characterized by accelerated destruction of the transfused RBC. Very common associated with secondary or anamnestic response
Delayed Hemolytic Transfusion Reaction (DHTR)
48
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)
49
Signs and symptoms of TA-GVHD: (4)
o Fever o Liver Problems o Rash o Diarrhea
50
Management of TA-GVHD
Transfusion of irradiated blood components
51
Onset of TA-GVHD
TA-GVHD’s onset is 2 days to 6 weeks after transfusion
52
Characterized by severe thrombocytopenia 1 week after transfusion due to antibody to platelet specific antigen
Post-Transfusion Purpura
53
Iron deposition in vital organs seen in patients who have RBC abnormalities: Thalassemia and who undergoes massive/chronic transfusion
Transfusion-Induced Hemosiderosis (Iron Overload)
54
ACUTE, IMMUNOLOGIC TRANSFUSION REACTIONS: (4)
1. Acute/Immediate Hemolytic Reactions 2. Febrile Non-Hemolytic Transfusion Reaction (FNHTR) 3. Allergic Transfusion Reaction 4. Anaphylactic Transfusion Reaction
55
ACUTE, NON-IMMUNOLOGIC TRANSFUSION REACTIONS: (4)
1. Bacterial Contamination 2. Transfusion-Associated Circulatory Overload (TACO) 3. Transfusion-Associated Dyspnea (TAD) 4. Hypotensive Transfusion Reaction
56
DELAYED ADVERSE EFFECTS OF TRANSFUSION (IMMUNOLOGIC): (3)
1. Delayed Hemolytic Transfusion Reaction (DHTR) 2. Transfusion-Associated Graft vs. Host Disease (TA-GVHD) 3. Post-Transfusion Purpura
57
DELAYED, ADVERSE EFFECTS OF TRANSFUSION (NONIMMUNOLOGIC): (2)
1. Transfusion-Induced Hemosiderosis (Iron Overload) 2. Transmission of Diseases

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