Blood Transfusion Reactions Flashcards
Components of blood
RBCs
Platelets
Plasma
Types of Plasma
Fresh Frozen Plasma
Cryoprecipitate
Units of plasma
Fresh Frozen Plasma = 3-4U per dose
Cryoprecipitate = 10U per dose
Non UK Plasma
Methylene Blue FFP = for children = single donor = US sourced
Solvent Detergent plasma = octapharma = needs 500-1000 pooling = plasma exchange TTP
Immune adverse effects of transfusion
- wrong blood compatibility
- Urticarial rash
- anaphylaxis
- immunomodulation
- DHTR (other RBC AB = Rh)
- FNHTR
- PTP
- TRALI
- TA-GVHD
Non immune non-infectious adverse effects of transfusion
- iron overload
- fluid overload (TACO)
Infectious adverse effects of transfusion
- viral = HBV, HCV, HIV, HTLV, CMV, EBV, parovirus, rarely HAV
- bactericidal
- syphilis
- parasites (malaria, trypanosomiasis)
- prions
Commonest blood group
O then A then AB then B
Acute Haemolytic reaction cause and presentation
- soon after starting transfusion
- ABO incompatible
- immediately complement mediated lysis
- shock, high fever, kidney failure, death
What are acute haemolytic reactions often due to? Which is most common?
- 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)
Management of acute haemolytic reaction?
- 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
Delayed haemolytic transfusion reaction cause and presentation
- 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
Diagnosis of delayed haemolytic transfusion reaction
- Direct Antiglobulin test positive
FNHTR presentation
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
Urticarial rash Presentation
Can be accompanied by wheeze
Not severe
Hypersensitivity to random plasma protein
Anaphylaxis Presentation
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
What are the pulmonary complications?
- TACO = transfusion associated circulatory overload
- TRALI = transfusion associated acute lung injury
TACO RF
Transfusion associated circulatory overload
- elderly
- pre-existing heart disease
- low body weight given large volume transfusion
TACO Management
Assess patients at risk at pre-transfusion
TRALI cause
- transfused anti-leucocyte ABs in donor plasma interact with patients WBCs
TRALI presentation
Bilateral pulmonary infiltrates
TRALI management
- supportive
- ventilation
Rare complication
PTP = post transfusion purpura Ta-GVHD = Transfusion Associated Graft vs. Host Disease
PTP
- 7-10 days after
- destruction of own platelets eventually
- HPA1 negative patients form ABs
- after transfusion or pregnancy
Ta-GVD
- always fatal
- lymphocytes in donor blood transfused to immunocompromised host
- prevent by giving irradiated blood and platelets
Organisms transmitted by blood transfusion
- 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
Commonest infective organism in blood tranfusion
Hep B
Then HIV
Then Hep C
Effects of bacterial contamination
- rare but fatal
- bacterial sepsis = especially if endotoxin produced (E coli)
- shock, kidney failure, death
Prevention of bacterial contamination
- stringent cleansing
- BACT Alert = bacterial screening of platelets
Prion Disease
- transmitted by blood in sheep and humans
- no blood test available only biopsy
Prion Disease Transmission RIsk Reduction Strategies
- 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
Surgery Pre-Op Blood Management
- correct iron deficiency anaemia
- review warfarin, antiplatelet drugs
Cell Salvage
- collect patients own blood during major surgery
Antifibrinolytics
Tranexamic acid to reduce blood loss
Restrictive transfusion triggers
Hb<70g/l
Hb<80g/l if ACS
Blood Management in Surgery
Pre-Op Assess Cell Salvage Antifibrinolytics Near patient testing to guide component usage Restrictive transfusion triggers
Consent
- 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
