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CSMLS > TM Transfusion Reactions > Flashcards

TM Transfusion Reactions Flashcards

1
Q

First 15 min of transfusion is slow and patient is monitored for any signs or symptoms of reaction. What must be done if there ARE SIGNS of reaction ?

A
  • STOP transfusion, maintain IV line, run saline
  • notify attending physician immediately
  • document vital signs and symptoms
  • perform bedside clerical check with the unit tag/vs patient (2 identifiers)
  • notify blood bank (they ask all of the above)
  • return unused product, along with post-transfusion specimen (EDTA) to blood bank

NOTE: EVEN minor reaction must be reported even if it was resolved within 20 mins

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2
Q

Significance of positive DAT days/ weeks after transfusion ?

A

STILL SIGNIFICANT; can indicate delayed transfusion rxn

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3
Q

Why does complement only bind in vivo ?

A

In vitro, EDTA chelates Ca2+ and Mg 2+ needed for complement

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4
Q

Outline a transfusion rxn investigation in the lab (8)

A
  1. Clerical check

Document:
2. Review symptoms (document on tag)
3. Note product transfused
4. Time of symptoms from transfusion (ie. minutes= severe allergic; week after = not febrile)
5. Volume transfused

  1. Check visible hemolysis on post-transfusion sample
  2. Serological tests: ABO Rh, Ab screen, DAT, XM
  3. Non-serological tests: Bilirubin, Hb, LDH, Haptoglobin
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5
Q

Which products will NOT cause a delayed hemolytic rxn ?

A

Plasma and Platelets

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6
Q

In the event of a transfusion rxn, what tests do we run on a pre-transfusion sample ?

A

(clerical check)
ABO Rh
Ab screen
Serological XM

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7
Q

In the event of a transfusion rxn, what tests do we run on a post-transfusion sample ?

A

(clerical check)
- check for visible hemolysis
- ABO Rh
- Abscr
- DAT
- serological XM

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8
Q

In the event of a transfusion rxn, what tests do we run on the donor segment ?

A

(clerical check)
ABO Rh
Antigen type for any Ab detected in the patient’s pre- or post-Antibody screen

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9
Q

5 Transmissible Diseases that are routinely screened

A
  1. Hepatitis B
  2. Hepatitis C
  3. Syphilis
  4. AIDS
  5. Adult T-Cell Lymphoma
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10
Q

Cause for Acute Hemolytic Rxn

A
  • ABO incompatibility = complement binding to C9 = IVH

Rare:
- pre-formed Ab in recipient
- no Ab screen/ unmatched blood (emergency)
- low frequency antigen (Cw, V, Kpa - Ab screen will be falsely neg)
- Kidd, Kell, Rh Ab

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11
Q

Immediate Hemolytic Rxns occur within __ minutes of transfusion

A

Immediate Hemolytic Rxns occur within 15 minutes of transfusion

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12
Q

Blood products associated to Immediate Hemolytic Rxn

A
  • RBC
  • plasma
  • platelets (less severe)
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13
Q

Immediate Hemolytic Rxn Symptoms

A
  • fever/ chills
  • chest pain/ shortness of breath
  • angioedema; “vessels swelling”
  • DIC
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14
Q

Causes of Febrile Non-Hemolytic Rxns

A
  • cytokines in platelet products
  • WBC antibodies in patient reacts with donor WBCs
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15
Q

Time of Febrile Non-hemolytic Reactions

A

2-4 hours from start of transfusion

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16
Q

Prevention of Febrile Non-hemolytic Rxns

A
  • pre-storage leukoreduction
  • washing products to remove contaminants
17
Q

Cause and Effect of Mild Allergic Reactions

A
  • Patient’s IgE Ab reacts with allergen in donor PLASMA (food, protein, preservative)
  • Ab binds mast cells = release granular contents (histamine) = urticarial and pruritis
  • BP and RESPIRATORY UNAFFECTED, with mild tachycardia

urticarial = hives
pruritis = itching
tachycardia = increased HR

18
Q

Time of Mild Allergic Rxns

A

1-45 min from start of transfusion

19
Q

Cause of Anaphylactic Allergic Rxns

A
  • donor IgA is the “antigen” !
  • recipient is IgA deficient and makes an anti-IgA from previous transfusions
  • can be an allergen ie. peanuts (rare)
20
Q

Time of Anaphylactic Allergic Rxns

A
  • WITHIN MINUTES (1-15 min) from start of transfusion
  • can start as mild and progresses
21
Q

Symptoms of Anaphylactic Allergic Rxns

A
  • urticaria, pruritis, dyspnea, low BP, hypoxemia, smooth muscle contractions (GI and respiratory), vasodilation

urticaria = hives
pruritis = itching
dyspnea = shortness of breath

22
Q

Prevention of Anaphylactic Allergic Rxns

A
  • request IgA deficient products
  • wash products to remove IgA
  • prepare drugs
  • transfuse with MD supervision
23
Q

Cause of Bacteriogenic Rxns

A

bacteria in PLATELETS and BLOOD products:

  • normal skin flora
  • transient bacteremia in donor (dental bleeding)
  • contamination during processing
  • improper temp storage
24
Q

Symptoms of Bacteriogenic Rxns

A
  • fever, chills
  • low BP
  • tachycardia
  • DIC
25
Q

Cause of Delayed Hemolytic Reaction

A
  • Ab formation to non-ABO Ag (Rh, Kell, Duffy, Kidd, Ss) on BLOOD products
  • EVH; Ab binds donor cells and removed by spleen
26
Q

Timing of Delayed Hemolytic Rxns

A
  • 2-14 days post-transfusion
  • due to secondary exposure
27
Q

Symptoms of Delayed Hemolytic Rxns

A
  • fever, chills
  • malaise
  • jaundice
  • no symptoms at all

malaise = discomfort

28
Q

A post- transfusion investigation takes into account… (3)

A
  1. type of products transfused
  2. signs and symptoms
  3. serological results from a post-transfusion sample
29
Q

T or F: Rh binds complement

A

FALSE; Rh DOES NOT bind complement

NOTE: (Rh)ude MeaN (Du)des don’t give out complements

30
Q

List other rare causes of positive post-transfusion DAT (3)

A
  • passive antibody
  • IVIg that binds non-specifically to RBC
  • donor is already DAT pos
31
Q

Describe Delayed Hemolytic Rxn Workup

A
  1. Ab ID if AbScr = pos
  2. Elution on DAT pos cells
  3. Ag type donor segment; DO NOT TYPE DONOR (transfused within 3 months)
  4. Update records
  5. Serological XM with suspect donors
  6. Serological XM Ag neg donors for next transfusion if collection still valid (96 hrs)
32
Q

What would cause a positive DAT on a post-transfusion sample ?

A
  • ABO incompatible cells = immediate hemolytic run
  • Mild allergic + severe anaphylactic rxn
  • Autoimmune hemolytic (warm/ cold) anemia
  • Drug-induced hemolytic anemia
  • HDFN
33
Q

If a patient has a delayed hemolytic rxn, why might the DAT = negative ?

A

All donor cells have been destroyed due to EVH before post-transfusion sample is collected

34
Q

What is GVHD ? Outline the cause, symptoms, blood products involved and prevention.

A

Graft vs Host Disease:
- donor WBCs are seen as foreign by immunocompromised and has reaction to self
- prevented by using irradiated blood

CSMLS (46 decks)

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