Blood Transfusion Reactions Flashcards
febrile non-hemolytic reaction
-caused by antibodies to donor leukocytes that remain in the unit of blood or blood component
-most common
- occurs more frequently in in pts who have had previous transfusions (exposure to multiple antigens from previous blood products) and in Rh-negative women who have borne Rh-positive children
-diagnosis is made by excluding other potential causes, such as a hemolytic reaction or bacterial contamination of the blood product
-s&s: chills (minimal to severe) followed by fever (more than 1°C elevation)
o The fever typically begins within 2 hours after the transfusion has begun
-can be diminished, even prevented, by further depleting the blood component of donor leukocytes
-Antipyretics can be given to prevent fever, but routine premedication is not advised because it can mask the beginning of a more serious transfusion reaction.
acute hemolytic reaction
-most dangerous, and potentially life-threatening, type of transfusion reaction occurs when the donor blood is incompatible with that of the recipient
-Antibodies already present in the recipient’s plasma rapidly combine with antigens on donor erythrocytes, and the erythrocytes are destroyed in the circulation
-The most rapid hemolysis occurs in ABO incompatibility
•causes: errors in blood component labelling and patient identification
•s&s: fever, chills, low back pain, nausea, chest tightness, dyspnea, and anxiety.
- As the erythrocytes are destroyed, the hemoglobin is released from the cells and excreted by the kidneys; therefore, hemoglobin appears in the urine (hemoglobinuria).
- Hypotension, bronchospasm, and vascular collapse may result.
-Diminished renal perfusion results in acute renal failure, and DIC may also occur.
-Tx: maintaining blood volume and renal perfusion and preventing and managing DIC
allergic reaction
• Some pts develop urticaria (hives) or generalized itching during a transfusion
• Symptoms of an allergic reaction are urticaria, itching, and flushing
• The reactions are usually mild and respond to antihistamines
o If the symptoms resolve after administration of an antihistamine, the transfusion may be resumed
• Reactions are managed with epinephrine, corticosteroids, and vasopressor support, if necessary
circulatory overload
- If too much blood is infused too quickly, hypervolemia can occur
- This condition can be aggravated in pts who already have increased circulatory volume (eg. Those with heart failure)
- If the administration rate is sufficiently slow, circulatory overload may be prevented
- Pts receiving fresh-frozen plasma or even platelets may also develop circulatory overload
signs and symptoms of circulatory overload
dyspnea, orthopnea, tachycardia, and sudden anxiety
o JVD, crackles at the base of the lungs, and an increase in BP can also occur
o If the transfusion is continued, pulmonary edema can develop, as manifested by severe dyspnea and coughing of pink, frothy sputum
treatment of circulatory overload
• If the overload is severe, the pt is placed in an upright position with the feet in a dependent position, the transfusion is discontinued, and the physician is notified
• The IV line is kept patent with a very slow infusion of normal saline solution or a saline or heparin lock device to maintain access to the vein in vase IV meds are necessary
o O2 and morphine may be needed to treat severe dyspnea
bacterial contamination
• Contamination can occur at any point during procurement or processing but often result from organisms on the donor’s skin
• Many bacteria cannot survive in the cold temps used to store PRBCs, but some organisms can do so
• Platelets are at greater risk of contamination bc they are stored @ room temp
• When PRBCs or whole blood is transfused, it should be administered within a 4-hour period, bc warm room temp promotes bacterial growth
• The signs of bacterial contamination are fever, chills, and hypoTN
o These signs may not occur until the transfusion is complete
• If the condition is not tx immediately with fluids and broad-spectrum antibiotics, septic shock can occur
transfusion-related acute lung injury
- potentially fatal, idiosyncratic reaction that occurs in less than 1 in 5000 transfusions, but as detection improves, the reported incidence will likely increase
• Thought to involve antibodies in the donors plasma that react to the leukocytes in the recipients blood
• Onset is abrupt (usually within 6 hours of transfusion, often within 2 hours)
• s&s: acute SOB, hypoxia (arterial oxygen saturation less than 90%), hypoTN, fever, and eventual pulmonary edema
• Diagnostic criteria include hypoxemia, bilateral pulmonary infiltrates (seen on chest xray), and no evidence of cardiac cause for the pulmonary edema
• Aggressive supportive therapy (eg, oxygen, intubation, fluid support) may prevent death
• Far more likely to occur when plasma and, to a lesser extent, platelets are transfused
delayed hemolytic reaction
- usually occur within 14 days after transfusion, when the level of antibody has been increased to the extent that a reaction can occur
• The hemolysis of the erythrocytes is extravascular via the RES and occurs gradually
• S+S: fever, anemia, increased bilirubin level, decreased or absent haptoglobin, and possibly jaundice. Rarely, there is hemoglobinuria
• Generally not dangerous but important to recognize bc subsequently transfusions with blood products containing these antibodies may cause a more severe hemolytic reaction
• The reaction is usually mild and requires no intervention
complications of long term transfusion therapy
- Pts with long-term transfusion requirements (eg. Those with MDS, thalassemia, aplastic anemia, sickle cell anemia) are at greater risk for infection transmission and for becoming more sensitized to donor antigens bc they’re exposed to more units of blood and more donors.
- Iron overload is a complication
how much iron is in one unit of PRBCs?
250mg
