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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
Q

Name two types of pulmonary complications due to blood transfusion

A
  • Transfusion associated circulatory overload (TACO)

- Transfusion related acute lung injury (TRALI)

26
Q

what is the difference between TACO and TRALI

A

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
Q

What patients are at risk of TACO

A
  • elderly patients
  • existing heart disease
  • very small patients given large volume of transfusion
28
Q

describe what causes TRALI

A
  • transfused anti- leucocyte antibodies in donor plasma which interact with the patients white blood cells
  • this leads to bilateral pulmonary infiltrate
29
Q

How do you manage TRALI

A
  • Supportive management

- Ventilation

30
Q

What does TACO stand for

A

Transfusion associated circulatory overload (TACO)

31
Q

What does TRALI stand for

A

Transfusion related acute lung injury (TRALI)

32
Q

Name the haemoviligance scheme

A

SHOT

33
Q

List the TACO checklist to see if they are at risk of TACO

A
  • 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
Q

What should you consider when doing a blood transfusion for someone who is at risk of TACO

A
  • 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
Q

What is PTP

A

post transfusion pleura

36
Q

What happens in post transfusion pleura

A

 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
Q

What happens in transfusion associated graft versus host disease

A

 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
Q

who are susceptible patients to transfusion associated graft versus host disease

A

 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
Q

How can you prevent transfusion associated graft versus host disease

A
  • irradiate the donors blood before transfusing

- irradiation makes donor lymphocytes unable to divide - so cannot mount immune response against patients tissues

40
Q

Name type of viruses that can be transferred

A

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
Q

What happens in a bacterial transfusion in a blood transfusion

A
  • Rare but can be fatal

- bacterial sepsis - especially if endotoxin produced e.g. gram negative rods (E.coli)

42
Q

What is the source of bacteria when bacteria is transmitted in a blood transfusion

A
  • Source donor skin - stringent cleansing, bacterial screening of platelets (BACT Alert)
43
Q

Describe symptoms of bacterial transfusion in blood

A
  • Shock
  • kidney failure
  • death
44
Q

how do you reduce prion disease

A

 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
Q

How do you idetify the patient

A
  • sample labelling
  • wrist band identification on the patient
  • the blood label
  • prescription chart
  • notes
46
Q

How do you do blood management in surgery

A

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
Q

What is the difference in symptoms between TACO and TRALI

A

TACO

  • hypertension
  • raised jugular venous pulse
  • afebrile
  • S3 presetn

TRALI

  • Hypotension
  • pyrexia
  • normal/unchanged JVP
48
Q

What serum does transfusion of red blood cells increase

A
  • increases serum potassium levels

Year 3 - CR (44 decks)

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