TM Transfusion Reactions Flashcards
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 ?
- 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
Significance of positive DAT days/ weeks after transfusion ?
STILL SIGNIFICANT; can indicate delayed transfusion rxn
Why does complement only bind in vivo ?
In vitro, EDTA chelates Ca2+ and Mg 2+ needed for complement
Outline a transfusion rxn investigation in the lab (8)
- 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
- Check visible hemolysis on post-transfusion sample
- Serological tests: ABO Rh, Ab screen, DAT, XM
- Non-serological tests: Bilirubin, Hb, LDH, Haptoglobin
Which products will NOT cause a delayed hemolytic rxn ?
Plasma and Platelets
In the event of a transfusion rxn, what tests do we run on a pre-transfusion sample ?
(clerical check)
ABO Rh
Ab screen
Serological XM
In the event of a transfusion rxn, what tests do we run on a post-transfusion sample ?
(clerical check)
- check for visible hemolysis
- ABO Rh
- Abscr
- DAT
- serological XM
In the event of a transfusion rxn, what tests do we run on the donor segment ?
(clerical check)
ABO Rh
Antigen type for any Ab detected in the patient’s pre- or post-Antibody screen
5 Transmissible Diseases that are routinely screened
- Hepatitis B
- Hepatitis C
- Syphilis
- AIDS
- Adult T-Cell Lymphoma
Cause for Acute Hemolytic Rxn
- 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
Immediate Hemolytic Rxns occur within __ minutes of transfusion
Immediate Hemolytic Rxns occur within 15 minutes of transfusion
Blood products associated to Immediate Hemolytic Rxn
- RBC
- plasma
- platelets (less severe)
Immediate Hemolytic Rxn Symptoms
- fever/ chills
- chest pain/ shortness of breath
- angioedema; “vessels swelling”
- DIC
Causes of Febrile Non-Hemolytic Rxns
- cytokines in platelet products
- WBC antibodies in patient reacts with donor WBCs
Time of Febrile Non-hemolytic Reactions
2-4 hours from start of transfusion
Prevention of Febrile Non-hemolytic Rxns
- pre-storage leukoreduction
- washing products to remove contaminants
Cause and Effect of Mild Allergic Reactions
- 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
Time of Mild Allergic Rxns
1-45 min from start of transfusion
Cause of Anaphylactic Allergic Rxns
- donor IgA is the “antigen” !
- recipient is IgA deficient and makes an anti-IgA from previous transfusions
- can be an allergen ie. peanuts (rare)
Time of Anaphylactic Allergic Rxns
- WITHIN MINUTES (1-15 min) from start of transfusion
- can start as mild and progresses
Symptoms of Anaphylactic Allergic Rxns
- urticaria, pruritis, dyspnea, low BP, hypoxemia, smooth muscle contractions (GI and respiratory), vasodilation
urticaria = hives
pruritis = itching
dyspnea = shortness of breath
Prevention of Anaphylactic Allergic Rxns
- request IgA deficient products
- wash products to remove IgA
- prepare drugs
- transfuse with MD supervision
Cause of Bacteriogenic Rxns
bacteria in PLATELETS and BLOOD products:
- normal skin flora
- transient bacteremia in donor (dental bleeding)
- contamination during processing
- improper temp storage
Symptoms of Bacteriogenic Rxns
- fever, chills
- low BP
- tachycardia
- DIC
Cause of Delayed Hemolytic Reaction
- Ab formation to non-ABO Ag (Rh, Kell, Duffy, Kidd, Ss) on BLOOD products
- EVH; Ab binds donor cells and removed by spleen
Timing of Delayed Hemolytic Rxns
- 2-14 days post-transfusion
- due to secondary exposure
Symptoms of Delayed Hemolytic Rxns
- fever, chills
- malaise
- jaundice
- no symptoms at all
malaise = discomfort
A post- transfusion investigation takes into account… (3)
- type of products transfused
- signs and symptoms
- serological results from a post-transfusion sample
T or F: Rh binds complement
FALSE; Rh DOES NOT bind complement
NOTE: (Rh)ude MeaN (Du)des don’t give out complements
List other rare causes of positive post-transfusion DAT (3)
- passive antibody
- IVIg that binds non-specifically to RBC
- donor is already DAT pos
Describe Delayed Hemolytic Rxn Workup
- Ab ID if AbScr = pos
- Elution on DAT pos cells
- Ag type donor segment; DO NOT TYPE DONOR (transfused within 3 months)
- Update records
- Serological XM with suspect donors
- Serological XM Ag neg donors for next transfusion if collection still valid (96 hrs)
What would cause a positive DAT on a post-transfusion sample ?
- ABO incompatible cells = immediate hemolytic run
- Mild allergic + severe anaphylactic rxn
- Autoimmune hemolytic (warm/ cold) anemia
- Drug-induced hemolytic anemia
- HDFN
If a patient has a delayed hemolytic rxn, why might the DAT = negative ?
All donor cells have been destroyed due to EVH before post-transfusion sample is collected
What is GVHD ? Outline the cause, symptoms, blood products involved and prevention.
Graft vs Host Disease:
- donor WBCs are seen as foreign by immunocompromised and has reaction to self
- prevented by using irradiated blood
