Lecture 4 - Adverse Reactions Flashcards
what does SHOT stand for?
serious hazards of transfusion
what does SHOT do?
it is voluntary and anonymous and makes recommendations on how to improve patient safety
what is SABRE?
serious adverse blood reactions and events
what two companies merged together in 2017?
MHRA and SHOT, SABRE reports to both
what reports does SHOT receive that are not reportable under BSQR?
solvent detergent fresh frozen plasma (octaplas) and anti-D immunoglobulin
what is a SAR?
an unintended response in a donor or in a patient that is associated with the collection or transfusion of blood or components
what reactions are associated with red cell antibodies?
acute haemolytic reaction and delayed haemolytic reaction
what are the clinical symptoms of an allergic/anaphylactic reactions?
hypotension associated with a wheeze, swelling of face or limbs or mucus membranes, flushing
how may an allergic reaction be caused?
if a patient has an allergy and the donor has consumed that allergen
what type of component are allergic reactions usually associated with?
plasma rich components such as platelets or FFP
what is an allergic reaction investigated for?
for an IgA deficiency
what are the symptoms of febrile reactions?
fever, sometimes with shivering, muscle pain or nausea
how are febrile reactions most commonly caused?
by antibodies directed against donor leucocytes and the HLA antigens or by pre-formed cytokines in the donor plasma
how have febrile reactions been reduced?
due to leucodepleted blood components
what cases makes febrile reactions more common?
more common in multi-transfused patients receiving red cells
what is the treatment of a febrile reaction?
paracetamol and slow transfusion
what is TA-GvHD
engrafted T lymphocytes from the transfused blood recognise the recipient as foreign and attack host tissues
what makes TA-GvHD more likely to occur?
first degree relative donations due to HLA similarities and in immunocompromised patients
how can TA-GvHD be prevented?
by irradiation
what does TACO stand for?
tranfusion associated circulatory overload
how can TACO be caused?
due to rapid transfusion of a large volume of blood
what increases the risk of TACO?
over the age of 60, cardiac or pulmonary failure, renal impairment, hypoalbuminemia or anaemia
what kind of patients are at an increased risk of TACO?
small patients such as elderly or children
what is TRALI?
transfusion related acute lung injury
how long does it take for TRALI to occur?
most cases present within 2 hours post transfusion with a max of 6 hours
with are the signs of TRALI?
severe breathlessness and a cough associated with pink froth, hypotension and fever and rigors
what kind of treatment is associated with TRALI?
supportive treatment, often in the ICU
how might close link of TACO and TRALI cause mortality in someone with TRALI?
if confused with TACO, powerful diuretics may be given which can worsen TRALI
what patients is white cell mediated TRALI common in?
females with previous pregnancies
what type of products is WCM TRALI common in?
plasma products
what is the mechanism for WCM TRALI?
the recipient must express the specific HLA or neutrophil receptors to which the donor blood has formed antibodies so the antibodies react with the neutrophils
how does pulmonary oedema occur with TRALI?
activated neutrophils damage the endothelium which leads to vascular leakage into alveolar space
what is cytokine mediated TRALI?
neutrophils accumulate in microvasculature and a soluble lipid accumulates which cause activation of neutrophils which then induce the release of cytokines which contributes to endothelial damage
what effects does cytokine mediated TRALI have on the lungs?
cause vascular leaks and pulmonary oedema
what are the differences between TACO and TRALI?
blood pressure is high in TACO yet low in TRALI, TACO improves with diuretics yet worsens TRALI
what is TAD?
transfusion associated dyspnoea
how is TAD characterised?
by respiratory distress within 24 hours of transfusion that does not meet the criteria of TACO or TRALI or an allergic reaction
what does PTP stand for?
post transfusion purpura
what is PTP?
unexpected thrombocytopenia 5-12 days post transfusion
what type of patients does PTP usually effect?
Middle Aged or elderly women who have been alloimmunised against HPA-1a during pregnancy or previously transferred men
what are the clinical features of PTP?
low platelet count, haemorrhage or widespread purpura and bleeding
what is the treatment of PTP?
high dose IV IgG
how has the incidence of TTI been reduced?
new generations of microbiological testing, diversion of first 20mls of blood
what is the most common TTI?
hepatitis B
what does ADU stand for?
avoidable or delayed or under transfused adverse event
what is an ADU?
where a transfusion of a blood component was clinically indicated by not undertaken or availability led to a delay
what is WCT?
wrong component transfused, patient transfused with component from incorrect blood group
what is SRNM?
special requirements not met, where a patient transfused with a component that did not meet specific requirements such as irradiated, HLA matched, antigen negative red cells
what is HSE?
handling and storage errors, component may be rendered unsafe after handling and storage
what effect does low temperatures have on blood components?
haemolysis in red cell units, activation of platelets, precipitation of coagulation factors
what effect does high temperatures have on blood components?
microbial infection, denaturing of coagulation factors
