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Year 3 - CR > Blood Transfusion Reactions > Flashcards

Blood Transfusion Reactions Flashcards

1
Q

What are non infectious complications of transfusion

A

Immune - Wrong blood (ABO incompatible)

  • DHTR - other red cell antibodies - Rh system, kell
  • FNHTR
  • urticatial rash
  • IgA deficiency
  • PTP
  • TRALI
  • TA-GVHD
  • Immunomodulation

non immune

  • iron overload
  • Fluid overload (TACO)
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2
Q

What are infectious complications of transfusion

A
  • Viral HBV, HCV, HIV, HTLV, CMV, EBV
  • bacterial
  • syphilis
  • parasites - malarai trypanosomiasis
  • prions
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3
Q

how many people are

  • A
  • B
  • AB
  • O
A
  • A - 42%
  • B - 9%
  • AB - 3%
  • O - 46%
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4
Q

are you born with AB antigens

A
  • you become exposed to AB antigens as you grow older so by about 26 months you have antigens against them
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5
Q

if you are rhesus negative how do you get rhesus positive antigens

A
  • pregnancy
  • transfusion
  • transplant
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6
Q

What happens in an ABO mismatch

A
  • There is complement activation
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7
Q

describe complement activation in ABO mismatch

A

Anti A and Anti B can be IgM or IgG

  • the IgM antibodies can activate complement membrane complex punching holes in the surface of red cells and you get acute intravascular haemolysis
  • you can get activation of complement
  • this leads to coagulation, inflammation, platelet aggregation, lung oedema,
  • mast cells can be activated and this causes activation of histamine and other vasoactive amines which causes cytokine release which lowers blood pressure
  • this can lead to shock and eventually renal failure
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8
Q

if you give the wrong blood it can be

A

fatal

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9
Q

How quickly does acute haemolytic reaction occur after transfusion

A
  • quickly - around 15 minutes
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10
Q

name the symptoms of acute haemolytic reaction

A
  • Shock
  • high fever
  • kidney failure
  • death
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11
Q

What is the most common near miss in transfusion

A
  • Wrong blood in tube (WBIT) 62.8% is most common near miss
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12
Q

How can you get wrong blood in tube

A

 Wrong patient details put on x-match sample
 Lab - muddle up 2 patients’ samples or results (uncommon)
 At bedside, wrong unit of blood collected and given to patient - not checked thoroughly (commonest)

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13
Q

What is the management for a wrong blood transfusion

A

 STOP Blood Transfusion
 Intravenous fluids to maintain blood pressure
 Full blood count, coagulation screen, chemistry
 Repeat Blood group pre and post samples
 Return blood unit to blood bank
 Blood cultures
 Intensive care, treatment DIC, dialysis

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14
Q

what does DHTR stand for

A
  • Delayed haemolytic transfusion reaction
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15
Q

What is a Delayed haemolytic transfusion reaction due to

A

Due to red cell Ab’s - IgG

 Rh system/ Kell/ Fya/ Jkb etc

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16
Q

What are the signs of a delayed haemolytic transfusion reaction

A
  • Failure of haemoglobin to rise

- jaundice

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17
Q

what test is positive in a delayed haemolytic transfusion reaction

A

DirectAntiglobulinTest(DAT)positive

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18
Q

How common are red cell antibodies which lead to delayed haemolytic transfusion reaction

A

 ~1% of transfused patients
 Much higher rates allo-immunisation in patients with Sickle Cell Disease ~ 20%
 give extended Rh and matched blood

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19
Q

What does FNHTR stand for

A

Febrile non-haemolytic transfusion reactions (white cell problem)

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20
Q

What happens in a Febrile non-haemolytic transfusion reactions

A

 Fever - rise in temp > 1°C ± shakes/ rigors

 ± increase in pulse

21
Q

What has caused less Febrile non-haemolytic transfusion reactions

A
  • Leucodepletion of blood and platelets - the filtering out of white blood cells
22
Q

what allergic reactions can occur due to a blood transfusion

A
  • urticarial rash

- anaphylaxis

23
Q

describe a urtical rash experienced due to a blood transfusion

A
  • often not severe

- hypersensitivity to a random plasma protein

24
Q

describe anaphylaxis experienced due to a blood transfusion

A

Severe, life-threatening reaction soon after transfusion started
 Wheeze/ asthma, increase pulse, increase BP (shock)
 Laryngeal oedema/ facial oedema
 Uncommonly may be related to IgA deficiency

25
Name two types of pulmonary complications due to blood transfusion
- Transfusion associated circulatory overload (TACO) | - Transfusion related acute lung injury (TRALI)
26
what is the difference between TACO and TRALI
TACO - PA pressure is greater than 18mmHg - improves with a diuretic TRALI - PA pressure is equal to or less than 18mmHg - does not improve with diuretic
27
What patients are at risk of TACO
- elderly patients - existing heart disease - very small patients given large volume of transfusion
28
describe what causes TRALI
- transfused anti- leucocyte antibodies in donor plasma which interact with the patients white blood cells - this leads to bilateral pulmonary infiltrate
29
How do you manage TRALI
- Supportive management | - Ventilation
30
What does TACO stand for
Transfusion associated circulatory overload (TACO)
31
What does TRALI stand for
Transfusion related acute lung injury (TRALI)
32
Name the haemoviligance scheme
SHOT
33
List the TACO checklist to see if they are at risk of TACO
- Does the patient have a diagnosis of heart failure - is the patient on a regular diuretic - do they have pulmonary oedema - do they have respiratory symptoms of an undiagnosed cause - is fluid balance clinically significantly positive - is the patient on concomitant fluids or have they been in the 24 hours - is there any peripheral oedema if yes for any of them - review the need for transfusion - does benefits outweigh costs - can the transfusion be safely deferred until the issue can be investigated, treated or resolved
34
What should you consider when doing a blood transfusion for someone who is at risk of TACO
- consider body weight dosing for red cells, - transfuse one unit and review symptoms of anaemia, - measure the fluid balance - Consider giving a prophylactic diuretic - monitor the vital sings closely including oxygen saturation
35
What is PTP
post transfusion pleura
36
What happens in post transfusion pleura
 7-10 days after transfusion (blood or platelets)  HPA 1 negative patients forms antibodies after transfusion or pregnancy  After further transfusion, destruction of own platelets
37
What happens in transfusion associated graft versus host disease
 Rare, but always fatal  Mediated through viable lymphocytes in Donor’s blood transfused to an immunocompromised host  Prevented by giving irradiated blood and platelets
38
who are susceptible patients to transfusion associated graft versus host disease
 Bone Marrow Transplant patients  Patients who had certain chemo drugs eg: fludarabine  Patients with Hodgkin’s disease  Fetus - if needs intra-uterine transfusion  Congenital immunodeficiency conditions  If donor happens to be HLA match
39
How can you prevent transfusion associated graft versus host disease
- irradiate the donors blood before transfusing | - irradiation makes donor lymphocytes unable to divide - so cannot mount immune response against patients tissues
40
Name type of viruses that can be transferred
Hepatitis viruses  HAV; HBV; HCV; HDV (needs HBV to survive) ``` Retroviruses  HIV (1+2+ other subtypes)  HTLV(1+2)  Herpes viruses  CMV; EBV; HHV8 ``` Parvovirus B19
41
What happens in a bacterial transfusion in a blood transfusion
- Rare but can be fatal | - bacterial sepsis - especially if endotoxin produced e.g. gram negative rods (E.coli)
42
What is the source of bacteria when bacteria is transmitted in a blood transfusion
- Source donor skin - stringent cleansing, bacterial screening of platelets (BACT Alert)
43
Describe symptoms of bacterial transfusion in blood
- Shock - kidney failure - death
44
how do you reduce prion disease
 Leucodepletion 1998  UK plasma not used for fractionation  Imported FFP for all patients born after 1996  Any recipient of blood after 1980 barred from donation
45
How do you idetify the patient
- sample labelling - wrist band identification on the patient - the blood label - prescription chart - notes
46
How do you do blood management in surgery
Pre-opAssessment  correction Iron deficiency anaemia,  Review warfarin, antiplatelet drugs Cell salvage  collecting patient’s own blood during major surgery Antifibrinolytics  tranexamic acid to reduce blood loss Near Patient Testing  to guide component usage Restrictive transfusion triggers  Hb <70g/l  Hb <80g/l if acute coronary syndrome
47
What is the difference in symptoms between TACO and TRALI
TACO - hypertension - raised jugular venous pulse - afebrile - S3 presetn TRALI - Hypotension - pyrexia - normal/unchanged JVP
48
What serum does transfusion of red blood cells increase
- increases serum potassium levels

Year 3 - CR (44 decks)

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