Risks of Blood Product Administration Flashcards

Question

What is a Delayed Hemolytic Transfusion Reaction?

Answer 1

Occurs 4-8 days up to 1 month post transfusion. -After apparently “compatible” cross match, transfused red cells are eliminated from the circulation after short interval following transfusion -Due to previous sensitization which waned over time to be undetectable in testing -Commonly involve antibodies against Rhesus, Kell, Kidd, or Duffy antigens, not ABO -Typically antibody-coated RBC sequestered extravascularly -Lysis occurs in the spleen and renal system

Answer 2

Evidence of hemolysis by 1st or 2nd week after the transfusion. Symptoms less severe, self-limiting May be identified by: -Low-grade fever -Increased bilirubin with or without mild jaundice -And/or an unexplained reduction in hgb concentration Tx: Supportive Care

Answer 3

Diagnosis confirmed by positive direct antiglobulin tests (Coombs test)

Answer 4

1) ABO and Rhesus (Rh) determination 2) The antibody screen (Indirect Coomb’s test) is performed to identify recipient antibodies against RBC antigens other than ABO -While the Coombs test looks for antibodies on the surface of the RBCs, Indirect Coombs looks at free flowing antibodies directed against RBCs 3) The Cross-Match, in which donor RBC’s are mixed with recipient serum -Detects antibodies in low titers or that don’t agglutinate easily -Assures optimum safety -Incident of serious reaction after transfusion with ABO and Rh compatible blood (screen) is < 1%

Answer 5

-Febrile reactions -Transfusion-Related Acute Lung Injury (TRALI) -Graft-versus-Host Disease (GVHD) -Transfusion-Related Immunomodulation (TRIM)

Answer 6

In patients who receive multiple RBC or platelet transfusions. -Develop antibodies to human leukocyte antigens (HLA) on passenger WBCs -On a subsequent transfusion, the antibodies attack the WBC antigen -Febrile reaction in 2% of PRBC, FFP, platelet transfusions -Leukoreduction reduces or prevents these reactions -Chills, resp distress, anxiety, HA/Myalgia -Tx: Tylenol -Coombs test will be negative

Answer 7

-Noncardiogenic form of pulmonary edema -Has been associated with administration of all blood components containing plasma -Most frequent with FFP, platelets (pheresis) -Incidence 1:5000 transfusions, mortality of 5-8% -Most common cause of transfusion-related death reported to FDA

Answer 8

Usually donor anti-leukocyte antibodies activate recipient WBCs. -The donor WBC antibodies were made after a previous transfusion. TRALI requires presence of pre-existing or pre-disposing inflammatory condition in recipient i.e trauma, sepsis, surgery Activated leukocytes sequestered in lung → capillary endothelial damage and ↑ permeability of the lung tissue.

Answer 9

-Clinical appearance similar to ARDs Within 6 hours of transfusion: -Dyspnea, fever, chills, labile BP -Noncardiogenic pulmonary edema -Bilateral infiltrates (CXR) Treatment: -Oxygen, ventilator with low TVs -No diuretics or corticosteroids needed

Answer 10

Impaired myocardial function & rapid, aggressive fluid therapy.

Answer 11

Associated with signs and symptoms of cardiac dysfunction (hx of CHF, low EF, etc.) and/or volume overload.

Answer 12

1) Restrictive transfusion strategy -Greater volumes of blood components = ↑ risk of TRALI 2) Universal leukoreduction -Will get rid of anti-leukocyte antibodies in both donors and recipients 3) Frequent source of anti-leukocyte antibodies are multiparous female donors and other donors who have had multiple transfusions -Limit these donors

Answer 13

PRBCs and platelets contain significant numbers of viable donor lymphocytes. -When transfused into an immunocompromised individual, the donor lymphocytes may become engrafted, proliferate, and establish an immune response against the recipient -In other words, the engrafted lymphocytes reject the host. -progresses from bone marrow suppression to pancytopenia

Answer 14

T-cell immune deficits, bone marrow transplants, Hodgkin’s lymphoma and maybe other hematologic malignancies, neonates who have undergone a exchange transfusion in utero, babies weighing less than 1200 gm at birth, other immunocompromised patients and Patients receiving blood from a first degree relative.

Answer 15

Only reported after transfusion of cellular blood components -Not after FFP, cryoprecipitate

Answer 16

Irradiate cellular blood products to inactivate the lymphocytes in transfused blood. -For immunocompromised patients -For direct donor units from 1° relatives -Leukoreduction decreases incidence but does not prevent GVHD -Irradiation only effective means to prevent GVHD

Answer 17

Allogenic blood transfusions associated with immunosuppression &/or proinflammatory effects -First seen in renal transplant patients (less likely to reject organ if received a blood transfusion) -Likely due to transfused WBCs -Adverse effects of immunosuppression: increased recurrence of malignancies, increased rate of infections, and increase in mortality in the short term.

Answer 18

During blood storage, bioactive substances such as cytokines, cell membrane breakdown products, and complement accumulate leading to an inflammatory response and multiorgan dysfunction. -Consider Leukoreduction of all blood products