Blood Transfusion Reactions Flashcards
Transfusion Reactions are _______ associated with the _________ and _________
adverse reactions
transfusion of blood and its components
ANY __________ is considered a transfusion reaction of blood treatment.
unfavorable consequence
The risks of transfusion must be weighed against the benefits
T/F
T
Transfusion reactions can either be _________ which occurs in _____ or ________ which occurs in _______
Acute ; less than 24 hours
Delayed; greater than 24 hours
Acute transfusion reactions can either be ———- or _________
Immunologic or non-immunologic
List the acute immunologic transfusion reactions
Hemolytic
Febrile non-hemolytic
Allergic
Anaphylactic
Transfusion reaction of acute lung injury
List the acute non- immunologic transfusion reactions
Hemolytic
Circulatory overload
Air embolus
Hypothermia
Hypocalcemia
List the delayed non- immunologic transfusion reactions
Iron overload
Infections
List the delayed immunologic transfusion reactions
Hemolytic
Post transfusion purpura
Graft VS host disease
Acute transfusion reaction
Occurs in the first ______ of first _____ of blood
10-15 mins
50cc
Acute Haemolytic Transfusion Reaction
Aetiology:
-_______________ : _______ jn recipient Lead to _____________ of donated Rbc
-occur within ________
Blood group incompatibility
Antibodies
intravascular destruction
minutes
Acute Haemolytic Transfusion Reaction
Prevention: ___________________
Give ABO compatible blood.
Acute Haemolytic Transfusion Reaction
Clinical features
-________ along infusion site
– ___________
– Abnormal _________/________/__________/_______
– Release of cytokines: ____,___________
– Renal failure/ _____uria, may progress
to…___uria
Pain
Shock
bleeding; DIC
Haemoglobinemia/uria
fever, hypotension
Olig; an
Febrile Non Haemolytic Transfusion Reaction
Definition:
– __________ during infusion of blood component
– Usually “(severe or mild?) & (benign or malignant?) ” = not life threatening
An INCREASE in temperature of 1OC
Mild and benign
Febrile Non Haemolytic Transfusion Reaction
Aetiology:
Recipient ______ to donor _______________ in the transfused blood component.
antibodies
WBCs & Cytokines
Febrile Non Haemolytic Transfusion Reaction
Seen in:
_________ patients
Multiple _______
– Previously __________
Multiply transfused
pregnancies
transplanted
Febrile Non Haemolytic Transfusion Reaction
Differentials:
__________ reaction
_____ contamination of unit
Haemolytic transfusion
Bacterial
Febrile Non Haemolytic Transfusion Reactionl
PREVENTION
__________ (____- storage reduction may be more effective than ____- storage reduction) or plasma removal is also helpful.
Leukocyte reduction
pre
Post
Allergic (Urticarial-Hives) Transfusion Reactions
Aetiology:
______ hypersensitivity triggered by _________ directed against:
– Donor _________ or
Other allergens (food, medicines) in donor plasma
Cutaneous
recipient antibodies
plasma proteins
Allergic (Urticarial-Hives) Transfusion Reactions
Begins within _______ of infusion
Characterized by _____,______, or ______
Common or Rare?
Usually involves release of _______
Minutes
rash, and/or hives and itching
Common
histamine
Allergic (Urticarial-Hives) Transfusion Reactions
MUST be sure that the only reaction is the development of ______
No:
•________
____________
___________
urticarial
angioneurotic edema
laryngeal edema
bronchial asthma
Allergic (Urticarial-Hives) Transfusion Reactions
Prevention: _________________ before transfusion
pre-treat recipient with anti- histamines
Anaphylaxis
Recipient is ________ & has _______ in serum
– Recipient _____ can react to even (small or large?) amounts of ______ in the plasma in any blood component
• Reaction may occur within _______ : Onset of symptoms is ______
IgA deficient; anti-IgA
anti-IgA; small; donor IgA
minutes; SUDDEN
Anaphylaxis
PREVENTION:
_____ cellular components or blood products from ________
Wash
IgA deficients
Anaphylaxis
Symptoms
–_______ sensation at infusion site
– Coughing, difficulty in breathing, and bronchospasms can lead to ________
– Nausea, vomiting, severe abdominal cramps, diarrhea
– _____tension which can lead to _____,_____, and _______
– (FEVER or NO FEVER ?)
Burning
cyanosis
Hypo
shock, loss of consciousness, & death
No fever
TRALI
TRALI
Acute onset of _____ and _______ on CX-RAY within ______ of transfusion without evidence of _______
hypoxemia and pulmonary edema
6 hrs
cardiac failure.
TRALI
Primary Suspect:____________ to _____________
Another cause:
________________ in the lungs causing _______
Donor antibodies to recipient WBCs
Biologically active lipids; edema
TRALI
Clinical features
Chills, _______, cough, cyanosis, ____tension, increased difficulty breathing
fever
Hypo
TRALI
Prevention:
– For recipients : give _____________
- For donors: ________/_______
male products
watch/defer
Transfusion Associated Circulatory overload(TACO)
Aetiology
___________________
Rapid increases in blood volume to patient
Transfusion Associated Circulatory overload(TACO)
Risk factors:
– compromised _____________
– small _______________(elderly, young children),
– severe _____________
cardiovascular function,
intravascular volume
chronic anemia.
Transfusion Associated Circulatory overload(TACO)
Prevention:
– ______________
Treatment:
Stop infusion and ________________
Slow Transfusion
place patient in sitting position.
Transfusion Associated Circulatory overload(TACO)
Clinical features:
–______,________, severe headaches, _______tension or ____ (congestive heart failure).
Dyspnea, cyanosis
hyper
CHF
Transfusion Associated Circulatory overload(TACO)
Chest X-Ray
__________,__________,_________________
pulmonary edema, distended pulmonary artery, cardiomegaly
Transfusion Associated Circulatory overload(TACO)
Laboratory
elevated _____________ is 81% sensitive and 89% specific
B-natriuretic peptide (BNP)
Physical or chemical induced red cell destruction
Etiology:
Destruction of red blood cells in the ————— and infusion of _____________
collection bag
free hemoglobin, etc
Physical or chemical induced red cell destruction
Cause:
Improper __________
__________ haemolysis
__________ haemolysis
temperatures
Osmotic
Mechanical
Physical or chemical induced red cell destruction
Prevention :
__________________ for all aspects of procuring, processing, issuing and administering red blood cell transfusions.
Adherence to procedures
Hypocalcaemia
Excess _______: When infused at rate >_____ mL/minute or individuals with __________ function
citrate
100
impaired liver
Hypocalcaemia
Citrate is broken down by _______.
Citrates chelates _______ leading to hypocalcaemia
Seen more in _____ and ______ patients
liver
calcium
pediatric and elderly
Hypocalcaemia
Signs and Symptoms: _________, nausea, vomiting.
Prevention: ________ or __________ infusion.
Facial tingling
Slowing or discontinuing
Hypothermia
Etiology: Drop in core body temperature due to ____________________________
rapid infusion of large volumes of cold blood.
Hypothermia
Symptoms: ——-eased body temperature and _____ ______
Seen in small ______ or massive _______
Decr
ventricular arrhythmias.
infants; transfusion
Hypothermia
Prevention: Reduce rate of infusion or use ___________
blood warmers.
Air embolism
Etiology: If blood in an open system is ____________ or if air enters the system while __________________ are being changed.
infused under pressure
container or blood administration sets
Air embolism
Treatment: Place patient on (left or right?) side with _________ to displace air bubble from _______________
•
Left
Head down
pulmonic valve.
Delayed (>24 Hours) Transfusion Reaction -
Immunologic
__________,_______,____________
Nonimmunologic
______________
Haemolytic ; Graft vs. Host Disease; Posttransfusion Purpura
Iron Overload
Delayed Haemolytic Transfusion Reaction (red blood cell alloimmunization)
Onset within _____ (>________)
Associated with _______ Haemolysis
days; 24 hours
Extravascular
Delayed Haemolytic Transfusion Reaction (red blood cell alloimmunization)
Etiology: Antibodies that ______________ : ____,_____ etc
Prevention: Give _________________
usually do NOT
activate Complements
Rh, Kell,
antigen negative blood.
Delayed Haemolytic Transfusion Reaction
Signs & Symptoms
______________
_________
Unexpected _______
Fever or fever & chills
Jaundice; anemia
Delayed Haemolytic Transfusion Reaction
Some may present as ________ of an anticipated increase in ________ and _________
an ABSENCE
Hemoglobin and hematocrit.
Graft VS host disease
Etiology:_________________ attack ___________.
Very rare in blood stored _____ days due to __________
Donor CD8+ T-Lymphocytes
recipient (host) tissues
4+
WBC inactivation
Graft VS host disease
Groups at risk:
–______________ patients (Cancer, fetus, neonatal, bone marrow transplant).
Immunocompromised
Graft VS host disease
•Signs: ________,________, or erythroderma, ______, diarrhea, pancytopenia, etc.
Prevention: _______ of blood products.
Fever, dermatitis
hepatitis
Irradiation
Post- Transfusion Purpura
Etiology:————- to _________ causes abrupt ___________ of ____________
(platelet count < ________/l) 5-10 days following transfusion.
Antibodies to platelet antigens (HP1a )
onset of severe thrombocytopenia
10,000
Post- Transfusion Purpura Usually affects _______ women .
multiparous
Post- Transfusion Purpura
Signs: _______,__________, _____ in platelet count
Purpura, bleeding
fall
Post- Transfusion Purpura
treatment: _______,___________ or ___________
_________ are usually NOT recommended
IVIG, plasmapheresis or corticosteroids
platelet transfusions
Iron overload
Etiology: Excess iron resulting from __________________ such as those suffering from ___________,_________, etc.
chronically transfused patients
hemoglobinopathies, chronic renal failure
Iron overload
Signs: Muscle _______, fatigue, weight loss, mild ________, anemia, etc
Treatment: Infusion of _________ - an ________________ agent has been useful.
weakness
jaundice
deferoxamine
Iron chelating
Bacterial Contamination
Aetiology
At time of collection: either from ________ or __________.
• During _________________, etc.
the donor or the venipuncture site
component preparation
Bacterial Contamination
Usually involves endotoxins
T/F
T
Bacterial Contamination
Components:
– Most often from ______ components (______ temp).
Red cell units will look ______
platelet
room
dark
Bacterial Contamination
Symptoms: (slow or rapid ?) onset
________ , _____tension, shaking chills, muscle pain, Vomiting, abdominal cramps, ________ , _______uria, ___, renal failure, & _____.
Rapid
Fever; hypo
bloody diarrhea
hemoglobin; shock
DIC
Bacterial Contamination
Transfusion must be stopped immediately
_________ and _______ should be done on the _________,_______, and _________ .
__________ antibiotics should be given immediately intravenously
Gram stain & blood cultures
unit, patient and all infusion sets
Broad-spectrum
Bacterial contamination
Prevention: Maintain _______ of donor selection, blood collection and proper maintenance of collected blood components.
standards
Other Infectious Complication
___________
________
___________
______
VIRAL
PARASITE
Bacterial
Prion diseases
Other Infectious Complication
VIRAL:
•______,_______,_________,______
PARASITE:
•______,_______,__________
Bacterial: –_________*
Prion diseases:____________ Disease
HIV,Hepatitis B and C*, HTLV West nile
Babesia microti, Malaria, Trpanosoma cruzi
Syphilis
Creutzfeldt-Jacob
Massive transfusion
____ body volume in ________
“_________” coagulopathy
One ; 24 hours
Dilutional
Massive transfusion
“Dilutional” ___________
– depleted __________
– thrombocyt_________
– ____ perfusion
– confounding conditions: ____,_____
coagulopathy
coagulation factors
openia
Hypo
DIC, sepsis
In Summery: when shit happens
1- _______ immediately and ___________ with ________
2-______,_________,________
3- ______ the clinician
4-Check vital signs every _________
5-Check labels,forms,and Ids
6-Send bags &patient’s blood to BB
7-Minor(______,______________) VS Serious (___________)
Stop transfusion; keep an IV open with normal Saline
Corticosteroid, antihistamine, antipyretic
Contact; clinician
15 minutes
allergic-febrile non-hemolytic
hemolytic &febrile
ACUTE RESPIRATORY DISTRESS
_______
____________
________________
________________
Anaphylactic
TACO
Transfusion-Related Acute Lung Injury (TRALI)
Acute hemolytic transfusion reactions - Immune
- Non-immune
PULMONARY OEDEMA
_____________
________________
Transfusion-Related Acute Lung Injury (TRALI (non-cardiogenic)
Circulatory overload (cardiogenic)
Fever /CHILLS
_________________
_________________
_________________
_________________
_________________
Non-hemolytic febrile transfusion reactions
Acute Immune hemolytic transfusion reactions
Bacterial sepsis
Delayed Hemolytic Transfusion Reactions (DHTR)
Transfusion-Related Acute Lung Injury (TRALI)
HYPOTENSION/SHOCK
_______
__________
_________
_________
Acute hemolytic transfusion reactions Bacterial sepsis
Anaphylactic
Transfusion-Related Acute Lung Injury (TRALI)
HAEMOGLOBINAEMIA/HAEMO GLOBINURIA
_________
___________
Immune hemolytic transfusion reactions Bacterial sepsis
Transfusion reactions are mostly due to ————- and can range from ———— to _________
clerical errors
benign reactions to life threatening emergencies
Transfusion reactions
____________,_____________ and instituting supportive care are key to management.
.
Early detection, discontinuation of transfusion
Reporting of only some reactions helps to improve standard practices and reduce future occurrences
T/F
F
All
Anaphylaxis
Life threatening or benign reaction
Life threatening emergency
Acute Haemolytic Transfusion Reaction
Life threatening or benign reaction
Life threatening
Febrile Non Haemolytic Transfusion Reaction
Life threatening or benign reaction
Benign