Blood Transfusion Reactions

Question 1

Components of blood

Answer 1

RBCs
Platelets
Plasma

Question 2

Types of Plasma

Answer 2

Fresh Frozen Plasma

Cryoprecipitate

Question 3

Units of plasma

Answer 3

Fresh Frozen Plasma = 3-4U per dose

Cryoprecipitate = 10U per dose

Question 4

Non UK Plasma

Answer 4

Methylene Blue FFP = for children = single donor = US sourced
Solvent Detergent plasma = octapharma = needs 500-1000 pooling = plasma exchange TTP

Question 5

Immune adverse effects of transfusion

Answer 5

• wrong blood compatibility
• Urticarial rash
• anaphylaxis
• immunomodulation
• DHTR (other RBC AB = Rh)
• FNHTR
• PTP
• TRALI
• TA-GVHD

Question 6

Non immune non-infectious adverse effects of transfusion

Answer 6

• iron overload

- fluid overload (TACO)

Question 7

Infectious adverse effects of transfusion

Answer 7

• viral = HBV, HCV, HIV, HTLV, CMV, EBV, parovirus, rarely HAV
• bactericidal
• syphilis
• parasites (malaria, trypanosomiasis)
• prions

Question 8

Commonest blood group

Answer 8

O then A then AB then B

Question 9

Acute Haemolytic reaction cause and presentation

Answer 9

• soon after starting transfusion
• ABO incompatible
• immediately complement mediated lysis
• shock, high fever, kidney failure, death

Question 10

What are acute haemolytic reactions often due to? Which is most common?

Answer 10

• human errors
• wrong patient details on sample
• muddle up 2 patients samples/results in lab (least common)
• bedside wrong unit of blood collected and given (commonest)

Question 11

Management of acute haemolytic reaction?

Answer 11

• STOP transfusion
• IV fluids to maintain BP
• FBC, coag screen, chemistry
• Repeat blood group pre and post samples
• return blood unit to blood bank
• culture blood
• intensive care, manage DIC, dialysis

Question 12

Delayed haemolytic transfusion reaction cause and presentation

Answer 12

• due to IgG in RBCs
• 7-10 days post transfusion
• jaundice
• failure of Hb to rise
• higher rates in patients with Sickle cell as have more ABs

Question 13

Diagnosis of delayed haemolytic transfusion reaction

Answer 13

• Direct Antiglobulin test positive

Question 14

FNHTR presentation

Answer 14

Febrile non-haemolytic transfusion reactions

• during or soon after
• fever, shakes/rigors, high pulse
• unpleasant but not life threatening
• need to exclude wrong blood or bacteria infection

Question 15

Urticarial rash Presentation

Answer 15

Can be accompanied by wheeze
Not severe
Hypersensitivity to random plasma protein

Question 16

Anaphylaxis Presentation

Answer 16

Severe, life threatening
Soon after transfusion started
With wheeze, asthma, high pulse, low bp = shock
laryngeal and facial oedema
May be related to IgA deficiency but uncommon

Question 17

What are the pulmonary complications?

Answer 17

• TACO = transfusion associated circulatory overload

- TRALI = transfusion associated acute lung injury

Question 18

TACO RF

Answer 18

Transfusion associated circulatory overload

• elderly
• pre-existing heart disease
• low body weight given large volume transfusion

Question 19

TACO Management

Answer 19

Assess patients at risk at pre-transfusion

Question 20

TRALI cause

Answer 20

• transfused anti-leucocyte ABs in donor plasma interact with patients WBCs

Question 21

TRALI presentation

Answer 21

Bilateral pulmonary infiltrates

Question 22

TRALI management

Answer 22

• supportive

- ventilation

Question 23

Rare complication

Answer 23

PTP = post transfusion purpura
Ta-GVHD = Transfusion Associated Graft vs. Host Disease

Question 24

PTP

Answer 24

• 7-10 days after
• destruction of own platelets eventually
• HPA1 negative patients form ABs
• after transfusion or pregnancy

Question 25

Ta-GVD

Answer 25

- always fatal - lymphocytes in donor blood transfused to immunocompromised host - prevent by giving irradiated blood and platelets

Question 26

Organisms transmitted by blood transfusion

Answer 26

- persist in circulation for a long time - donor has infection for a while = exclude unwell donors - HBV, HCV, HEV, HAV - HIV, HTLV, Herpees, CMV, EBV, HHV8 - Parovirus B19

Question 27

Commonest infective organism in blood tranfusion

Answer 27

Hep B Then HIV Then Hep C

Question 28

Effects of bacterial contamination

Answer 28

- rare but fatal - bacterial sepsis = especially if endotoxin produced (E coli) - shock, kidney failure, death

Question 29

Prevention of bacterial contamination

Answer 29

- stringent cleansing | - BACT Alert = bacterial screening of platelets

Question 30

Prion Disease

Answer 30

- transmitted by blood in sheep and humans | - no blood test available only biopsy

Question 31

Prion Disease Transmission RIsk Reduction Strategies

Answer 31

- leucodepletion in 1998 - UK plasma not used for fractionation - barr patients who receieved blood after 1980 for donation - import FFP for all patient born after 1996

Question 32

Surgery Pre-Op Blood Management

Answer 32

- correct iron deficiency anaemia | - review warfarin, antiplatelet drugs

Question 33

Cell Salvage

Answer 33

- collect patients own blood during major surgery

Question 34

Antifibrinolytics

Answer 34

Tranexamic acid to reduce blood loss

Question 35

Restrictive transfusion triggers

Answer 35

Hb<70g/l | Hb<80g/l if ACS

Question 36

Blood Management in Surgery

Answer 36

``` Pre-Op Assess Cell Salvage Antifibrinolytics Near patient testing to guide component usage Restrictive transfusion triggers ```

Question 37

Consent

Answer 37

- valid consent required before planned transfusion and documented in patient record - give info on risks, benefit, alternatives then ask consent - does not need to include signature from patient