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Immunity Week 3 > ICL 12.1: Transfusion Reactions > Flashcards

ICL 12.1: Transfusion Reactions Flashcards

1
Q

what is a transfusion reaction?

A

an adverse outcome associated with the infusion of blood or blood components

any adverse event occurring at the time of transfusion should be considered a transfusion reaction, unless proven otherwise

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2
Q

in what time frame is an acute reaction?

A

within 24 hours of a blood transfusion

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3
Q

what are the two classifications of transfusion reactions?

A

acute vs delayed

acute and delayed each have immunological and non-immunological reactions

acute transfusion reactions are more life threatening than delayed reactions

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4
Q

what are the the types of acute immunological transfusion reactions?

A
  1. hemolytic transfusion reactions
  2. non hemolytic reactions
  3. allergic reactions
  4. transfusion-related acute lung injury
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5
Q

what is an immunological reaction?

A

anything related to antibody response, production or reaction

like IgM binding to RBC or alloantibodies binding to HLA are immunological reaction

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6
Q

what is an acute allergic reaction?

A

a type of acute immunological reaction

this means the recipient of the blood transfusion already has an immunological response to antigens in the donor blood

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7
Q

what is transfusion-related acute lung injury?

A

a type of acute immunological reaction

this is when antigens are present in the lungs are patients have lung problems prior to a blood transfusion

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8
Q

what is a non-hemolytic reaction?

A

it’s when antibodies recognize antigens but they don’t activate complement

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9
Q

what are the types of acute non-immunological transfusion reactions?

A
  1. transfusion-associated circulatory overload
  2. septic
  3. non immune hemolysis
  4. transfusion-related acute lung injury
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10
Q

what is transfusion-associated circulatory overload?

A

a type of acute non-immunological transfusion reaction

it’s mechanical overload due to giving too large of an infusion like when you give blood to a kid or to someone with bad circulation

this can be controlled quickly by slowing down the flow of blood till the symptoms stop

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11
Q

what are the types of delayed immunological transfusion reactions?

A
  1. alloimmunization to platelets, WBC
  2. hemolysis
  3. delayed serological transfusion reaction
  4. posttransfusion purpura
  5. transfusion-associated graft vs host disease
  6. immunomodulation
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12
Q

what are the types of delayed non-immunological transfusion reactions?

A
  1. transfusion-associated hemosiderosis

2. disease transmission

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13
Q

what is hemosiderosis?

A

a form of iron overload disorderresulting in the accumulation of hemosiderin

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14
Q

what are some presenting signs and symptoms of a transfusion reaction?

A
  • pruritis
  • urticaria
  • erythema
  • flushing
  • jaundice
  • fever, chills
  • tachycardia or bradycardia
  • hypo or hypertension
  • shock
  • NVD
  • headache
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15
Q

what are the 4 main signs of a transfusion reaction?

A
  1. fever
  2. rash
  3. shock
  4. respiratory distress
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16
Q

which transfusion reactions could cause fever?

A
  1. febrile non-hemolytic reaction (FNHR)
  2. hemolytic transfusion reaction (HTR)
  3. bacterial/septic
  4. transfusion-related acute lung injury (TRALI)
17
Q

which transfusion reactions could cause rash?

A
  1. allergic reaction

2. anaphylactic reaction

18
Q

what is circulatory shock?

A

a life-threatening medical condition of low blood pefusion to tissues resulting in cellular injury and inadequate tissue function

typical signs of shock are low blood pressure, rapid heart rate, and signs of poor end-organ perfusion

19
Q

what is anaphylaxis?

A

a serious allergic reaction that is rapid in onset and may cause death

it typically causes a number of symptoms including an itchy rash, throat swelling, and low blood pressure

common causes include insect bites and stings, foods, and medications.

20
Q

which transfusion reactions can cause shock?

A
  1. acute hemolytic transfusion reaction
  2. anaphylactic reaction
  3. sepsis
21
Q

which transfusion reactions can cause respiratory distress?

A
  1. hemolytic transfusion reaction
  2. anaphylacsis
  3. transfusion-related acute lung injury (TRALI)
  4. transfusion-associated circulatory overload (TACO)
22
Q

what steps should you take if you notice a transfusion reaction happening in a patient?

A

STOP the infusion

keep the intravenous line open

perform an immediate clerical check

peport to Blood Bank and patient’s physician

initiate studies to determine cause

start specific therapy if indicated

23
Q

what are the parts of a routine investigation following a transfusion reaction?

A
  1. clerical check = correct labeling
  2. visual check for hemolysis
  3. posttransfusion DAT
24
Q

what is a hemolytic transfusion reaction?

A

RBC hemolysis associated with transfusion

incompatible donor RBCs are coated with recipient’s serum IgM antibodies that fix complement leading to intravascular hemolysis

DAT test would be positive

we test for this by testing for antibodies and if they’re present you have to stop and do additional testing

25
Q

when do hemolytic transfusion reactions happen?

A

immune-mediated HTR occurs when there are alloantibodies, autoantibodies or medication associated

it can also be a non-immune HTR like from sepsis

26
Q

what are the characteristics of an acute hemolytic transfusion reaction?

A

within 24 hours

mostly intravascular

hemoglobinemia/hemoglobinuria

generally due to ABO incompatibility like from a misidentified sample or a diluted sample that led to a wrong readout of the blood group

not super common

27
Q

what are the characteristics of a delayed hemolytic transfusion reaction?

A

happens after 24 hours following blood transfusion

mostly extravascular

accumulation of heme breakdown products

due to IgG non-complement fixing antibodies or only C3 (like Rh antibodies)

more common than acute HTR

28
Q

what are the general symptoms of an acute hemolytic transfusion reaction?

A
  • fever and chills
  • pain, burning
  • nausea/vomiting
  • hypotension
  • tachycardia
  • dyspnea
  • flushing
  • agitation
  • hemoglobinemia/hemoglobinuria
29
Q

what are the symptoms of an acute hemolytic transfusion reaction while under anesthesia??

A

shock

diffuse bleeding at surgical site

hemoglobinuria

30
Q

what are the non-immunologic causes of hemolysis?

A
  1. kinking in tubes
  2. overheating of blood
  3. freeze/thaw
  4. bacterial contamination
  5. administration of large amounts of saline
  6. administration of fluids incompatible with blood through the same administration set

usually you can continue the blood transfusion if you just fix these things

31
Q

what are febrile nonhemolytic reactions?

A

fever

symptoms occur during and often towards the end of a transfusion

cytokine accumulation in the blood product, primarily

happens after multiple transfusions or multiple pregnancies

32
Q

what are allergic transfusion reactions?

A

generally mild hives and itching

itching, rash, tongue swelling, shortness of breath, low BP, vomitting

allergic antibody mediated response to donor proteins

IgE mediated

no fever!!

**you don’t need to stop the transfusion for this!

33
Q

what are anaphylactic transfusion reactions?

A

severe allergic reactions to transfused plasma-platelets, plasma

no fever!!

symptoms include flushing of the skin, pruritis, wheezing, hypotension, abdominal pain, diarrhea

***YOU MUST STOP THE TRANSFUSION IF THIS HAPPENS

34
Q

what is the mechanism behind an allergic transfusion reaction?

A

two options:

  1. the recipient has antibodies against allergens or proteins in the transfused blood like penicillin
  2. the recipients IgA antibodies against IgA in the transfused blood
35
Q

which transfusion reactions are associated with dyspnea?

A
  1. anaphylactic reactions
  2. HTR
  3. TRALI
  4. TACO
36
Q

what is TACO?

A

TACO = transfusion associated circulatory overload

rapid administration/excessive volume

patients with diminished cardiac reserve or chronic anemia

patients will usually have increased BP and complain about breathing (dyspnea)

TACO usually occurs within 24 hours and usually even within the first couple hours following a transfusion

you have to stop the blood transfusion and wait till symptoms subside and then you can safely continue but at a slower rate!

37
Q

what is TRALI

A

TRALI = transfusion related acute lung injury

acute onset of breathlessness

hypoxemia

bilateral infiltrates on frontal chest x-ray

happens within first 6 hours of transfusion

diagnosis is not dependent on the results of lab tests

not really sure why TRALI happens but people thing it’s because of antibodies directed toward HLA

usually it response in 48 hours all on its own

38
Q

which disease is at the highest risk of being transmitted during a blood transfusion?

A
  1. HepC
  2. HepB
  3. HIV
  4. HTLV
  5. CMV
  6. West Nile virus
  7. Syphilis

Immunity Week 3 (14 decks)

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