Blood Transfusion Reactions Flashcards by Iseoluwa Ojo

Transfusion Reactions are _______ associated with the _________ and _________

adverse reactions

transfusion of blood and its components

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ANY __________ is considered a transfusion reaction of blood treatment.

unfavorable consequence

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The risks of transfusion must be weighed against the benefits

T/F

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Transfusion reactions can either be _________ which occurs in _____ or ________ which occurs in _______

Acute ; less than 24 hours

Delayed; greater than 24 hours

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Acute transfusion reactions can either be ———- or _________

Immunologic or non-immunologic

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List the acute immunologic transfusion reactions

Hemolytic

Febrile non-hemolytic

Allergic

Anaphylactic

Transfusion reaction of acute lung injury

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List the acute non- immunologic transfusion reactions

Hemolytic

Circulatory overload

Air embolus

Hypothermia

Hypocalcemia

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List the delayed non- immunologic transfusion reactions

Iron overload

Infections

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List the delayed immunologic transfusion reactions

Hemolytic

Post transfusion purpura

Graft VS host disease

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Acute transfusion reaction

Occurs in the first ______ of first _____ of blood

10-15 mins

50cc

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Acute Haemolytic Transfusion Reaction

Aetiology:

-_______________ : _______ jn recipient Lead to _____________ of donated Rbc

-occur within ________

Blood group incompatibility

Antibodies

intravascular destruction

minutes

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Acute Haemolytic Transfusion Reaction

Prevention: ___________________

Give ABO compatible blood.

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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

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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

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Febrile Non Haemolytic Transfusion Reaction

Aetiology:

Recipient ______ to donor _______________ in the transfused blood component.

antibodies

WBCs & Cytokines

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Febrile Non Haemolytic Transfusion Reaction

Seen in:

_________ patients

Multiple _______

– Previously __________

Multiply transfused

pregnancies

transplanted

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Febrile Non Haemolytic Transfusion Reaction

Differentials:

__________ reaction

_____ contamination of unit

Haemolytic transfusion

Bacterial

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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

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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

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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

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Allergic (Urticarial-Hives) Transfusion Reactions

MUST be sure that the only reaction is the development of ______

No:
•________
____________
___________

urticarial

angioneurotic edema

laryngeal edema

bronchial asthma

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Allergic (Urticarial-Hives) Transfusion Reactions

Prevention: _________________ before transfusion

pre-treat recipient with anti- histamines

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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

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Anaphylaxis

PREVENTION:

_____ cellular components or blood products from ________

Wash

IgA deficients

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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

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