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ACP Hematology > L30 Adverse transfusion reaction > Flashcards

L30 Adverse transfusion reaction Flashcards

1
Q

PP: A patient with thalassemia trait presented with GU bleed and blood transfusion was given because of his low Hb level.
He developed flushing, shortness of breath, back pain 15 minutes after the blood transfusion.
1. What are the DDx? (2)
- briefly describe the pathologies. (2)

A

because of fever, pain, bleeding (DIC), shock

  1. Acute hemolytic transfusion reaction (AHTR)
    - ABO incompatibility > intravascular hemolysis
  2. Septic reaction due to bacterial contamination
    (e. g. Pseudomonas fluorescens, Yersinia)
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2
Q

PP: A patient with thalassemia trait presented with GU bleed and blood transfusion was given because of his low Hb level.
He developed flushing, shortness of breath, back pain 15 minutes after the blood transfusion.

What should you do immediately? (6)

A
  1. Stop transfusion
  2. Give IV fluid to maintain BP and renal perfusion
  3. Monitor the patient’s vital signs (temperature, BP, pulse, RR, O2 saturation)
  4. Crossmatch Patient’s identity
  5. Visual inspection of the blood component for any cloudiness
  6. Save patient’s and donor’s blood for investigation
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3
Q

PP: A patient with thalassemia trait presented with GU bleed and blood transfusion was given because of his low Hb level.
He developed flushing, shortness of breath, back pain 15 minutes after the blood transfusion.

What further investigations would you do other than bedside immediate management? (6)

A
  1. Check the patient’s identity
  2. Check recipient compatibility with blood units blood group
  3. Send patient’s blood, donor blood and give a set for culture and investigation
  4. CBC, Clotting, Renal function test and hemoglobinuria (urine multistix)
  5. Increase in bilirubin and LDH, reduced haptoglobin
  6. Direct Coomb’s test: for +ve agglutination
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4
Q

PP: A patient with thalassemia trait presented with GU bleed and blood transfusion was given because of his low Hb level.
He developed flushing, shortness of breath, back pain 15 minutes after the blood transfusion.

What will the red cell indices of this patient be?

A
  • Thalassemia - microcytic, hypochromic, increase % of reticulocytes
  • RBC count normal or increased
  • Histology: schistocytes (different shape), target cells, basophilic stippling
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5
Q

How can urine output be maintained in adverse transfusion reactions?

A
  • IV fluid
  • Diuretics
  • Dopamine
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6
Q

Specific management for septic reaction due to bacterial contamination?

A
  1. Give broad-spectrum antibiotics with pseudomonas coverage
    - Tazocin, Ceftazidime (Fortum)
  2. Urgent gram stain and culture
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7
Q

2017 MB SAQ7
A 40-year-old lady with a 3-year history of menorrhagia came in for an OGD complaining of ingestion of fishbone. No other complaints besides throat discomfort. Found Low Hb (7.8), normal WBC, normal platelet, low MCV (63), MCH (19). Iron profile shows low serum Fe and saturation (3%), high TIBC.

Dx?
What are the general considerations for red cell transfusion?

A

Iron deficiency anemia
- microcytic hypochromic anemia with low Fe, high TIBC

General considerations
- Level of Hb, if it is lower than 7, it is given.
If it is 7.5-10, a red cell is given depends on the underlying rate of blood lost.

  • Red cell may have to be given earlier if the patient has associated cardiovascular disease or age >65 years old.
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8
Q

2017 MB SAQ7
A 40-year-old lady with a 3-year history of menorrhagia came in for an OGD complaining of ingestion of fishbone. No other complaints besides throat discomfort. Found Low Hb (7.8), normal WBC, normal platelet, low MCV (63), MCH (19). Iron profile shows low serum Fe and saturation (3%), high TIBC.

  • Will you transfuse? justify your reason (3)
A

No.
She did not have any other anemic symptoms encountered
She is not undergoing active bleeding and there is no urgent need for normal hemoglobin such as preparation of surgery
- The patient can be effectively treated with Fe supplementation.

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9
Q

What is type and screen? (2)

A
  • Type: to check the ABO and Rh compatibility between donor and recipient
  • Screen: to check for the presence of abnormal Ab in the recipients
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10
Q

What are the 3 steps for identifying the patient in blood taking?

A
  1. Full name and HKID identified by verbal and wristband information
  2. Paperwork: transfusion request form
  3. Blood tube: check specimen label
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11
Q

What is the indirect Coomb’s test for in investigating blood transfusion reaction?

A

detect autoantibodies

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12
Q

Patient with urticaria, SOB, and shock after transfusion. What is the possible Dx?
Describe the pathogenesis (2) and also the specific management. (3)

A

Dx: Anaphylaxis
Pathogenesis
- sensitivity to donor plasma protein.

e.g. IgA deficiency or haptoglobin deficiency have anti-IgA or anti-haptoglobin antibodies which will react with IgA or haptoglobin in the donor unit

Specific management

  • Give adrenaline SC/IM
  • Resuscitation
  • ICU support
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13
Q

The patient presented with fever, SOB, shock, and bilateral symmetrical pulmonary edema after blood transfusion. He does not have any previous pulmonary medical history or predisposing cause for his symptoms.

Dx?
Management?

A

TRALI

  • Respiratory support
  • Diuretics NOT indicated
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14
Q

What is the pathogenesis of TRALI (Transfusion-related acute lung injury)?

A

Interaction between patient white cell antigens and donor’s antibodies (anti-HLA/anti-HNA human neutrophil antigen)

> complement-mediated leukocyte activation and endothelial damage in pulmonary capillaries

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15
Q

Patient presented with SOB, elevated JVP, ankle edema after blood transfusion.
Dx?
Mx?

A

TACO
- Transfusion-associated circulatory overload > volume overload

Mx:

  • Diuretics
  • Respiraotry support: O2, ventilation
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16
Q

Name the 2 types of minor transfusion reactions.

A
  1. Febrile non-hemolytic transfusion reaction (FNHTR)

2. Minor allergic reaction

17
Q

_________________ after blood transfusion only causes local cutaneous reactions only, e.g. urticaria, angio-edema.
It is due to patient’s sensitivity to ___________.

A

Minor allergic reaction

- donor’s plasma protein

18
Q

17 Q26 Which of the following transfusion reaction would not cause hypotension?

A. Acute hemolytic transfusion reaction
B. Sepsis
C. Anaphylaxis
D. TRALI 
E. Non-Febrile hemolytic transfusion reaction
A

E

  • only fever, flushing, tachycardia without any sinister features like hemolysis and sepsis
19
Q

What is Febrile non-hemolytic transfusion reaction (FNHTR)?

A

The immunological reaction between donor’s leukocytes and recipient antibodies against HLA/granulocytes //

Donor’s leukocyte-derived cytokine accumulation during storage (esp plts stored in room temperature)

20
Q

_______________ is the destruction of transfused red cells by antibody not detectable during the pretransfusion compatibility testing.

A

Delayed hemolytic transfusion reactions (DHTRs)

21
Q

Transfusion-associated graft-versus-host disease (TA-GvHD)

A. is fatal
B. there is engraftment and proliferation of donor lymphocytes in the recipient bone marrow > immune response
C. it may be due to the immunocompromised status of the recipient
D. it causes deranged liver function test
E. It is more frequent than transfusion-transmitted infections (TTI) nowadays

A

All of the above

E: TTI
- viral, bacterial, protozoal infections, prion: Variant Creutzfeldt-Jakob disease

22
Q

What is post-transfusion purpura (PTP)?

A
  • Re-stimulation of platelet-specific alloantibodies that damage their own platelets by an innocent bystander reaction
  • skin bruises

ACP Hematology (16 decks)

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