ICL 12.1: Transfusion Reactions Flashcards
what is a transfusion reaction?
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
in what time frame is an acute reaction?
within 24 hours of a blood transfusion
what are the two classifications of transfusion reactions?
acute vs delayed
acute and delayed each have immunological and non-immunological reactions
acute transfusion reactions are more life threatening than delayed reactions
what are the the types of acute immunological transfusion reactions?
- hemolytic transfusion reactions
- non hemolytic reactions
- allergic reactions
- transfusion-related acute lung injury
what is an immunological reaction?
anything related to antibody response, production or reaction
like IgM binding to RBC or alloantibodies binding to HLA are immunological reaction
what is an acute allergic reaction?
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
what is transfusion-related acute lung injury?
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
what is a non-hemolytic reaction?
it’s when antibodies recognize antigens but they don’t activate complement
what are the types of acute non-immunological transfusion reactions?
- transfusion-associated circulatory overload
- septic
- non immune hemolysis
- transfusion-related acute lung injury
what is transfusion-associated circulatory overload?
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
what are the types of delayed immunological transfusion reactions?
- alloimmunization to platelets, WBC
- hemolysis
- delayed serological transfusion reaction
- posttransfusion purpura
- transfusion-associated graft vs host disease
- immunomodulation
what are the types of delayed non-immunological transfusion reactions?
- transfusion-associated hemosiderosis
2. disease transmission
what is hemosiderosis?
a form of iron overload disorderresulting in the accumulation of hemosiderin
what are some presenting signs and symptoms of a transfusion reaction?
- pruritis
- urticaria
- erythema
- flushing
- jaundice
- fever, chills
- tachycardia or bradycardia
- hypo or hypertension
- shock
- NVD
- headache
what are the 4 main signs of a transfusion reaction?
- fever
- rash
- shock
- respiratory distress
which transfusion reactions could cause fever?
- febrile non-hemolytic reaction (FNHR)
- hemolytic transfusion reaction (HTR)
- bacterial/septic
- transfusion-related acute lung injury (TRALI)
which transfusion reactions could cause rash?
- allergic reaction
2. anaphylactic reaction
what is circulatory shock?
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
what is anaphylaxis?
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.
which transfusion reactions can cause shock?
- acute hemolytic transfusion reaction
- anaphylactic reaction
- sepsis
which transfusion reactions can cause respiratory distress?
- hemolytic transfusion reaction
- anaphylacsis
- transfusion-related acute lung injury (TRALI)
- transfusion-associated circulatory overload (TACO)
what steps should you take if you notice a transfusion reaction happening in a patient?
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
what are the parts of a routine investigation following a transfusion reaction?
- clerical check = correct labeling
- visual check for hemolysis
- posttransfusion DAT
what is a hemolytic transfusion reaction?
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
when do hemolytic transfusion reactions happen?
immune-mediated HTR occurs when there are alloantibodies, autoantibodies or medication associated
it can also be a non-immune HTR like from sepsis
what are the characteristics of an acute hemolytic transfusion reaction?
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
what are the characteristics of a delayed hemolytic transfusion reaction?
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
what are the general symptoms of an acute hemolytic transfusion reaction?
- fever and chills
- pain, burning
- nausea/vomiting
- hypotension
- tachycardia
- dyspnea
- flushing
- agitation
- hemoglobinemia/hemoglobinuria
what are the symptoms of an acute hemolytic transfusion reaction while under anesthesia??
shock
diffuse bleeding at surgical site
hemoglobinuria
what are the non-immunologic causes of hemolysis?
- kinking in tubes
- overheating of blood
- freeze/thaw
- bacterial contamination
- administration of large amounts of saline
- administration of fluids incompatible with blood through the same administration set
usually you can continue the blood transfusion if you just fix these things
what are febrile nonhemolytic reactions?
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
what are allergic transfusion reactions?
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!
what are anaphylactic transfusion reactions?
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
what is the mechanism behind an allergic transfusion reaction?
two options:
- the recipient has antibodies against allergens or proteins in the transfused blood like penicillin
- the recipients IgA antibodies against IgA in the transfused blood
which transfusion reactions are associated with dyspnea?
- anaphylactic reactions
- HTR
- TRALI
- TACO
what is TACO?
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!
what is TRALI
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
which disease is at the highest risk of being transmitted during a blood transfusion?
- HepC
- HepB
- HIV
- HTLV
- CMV
- West Nile virus
- Syphilis
