Transfusion complications

Question 1

transfusion reaction

Answer 1

any unfavorable response by a patient to an infusion

Question 2

Signs of transfusion reactions

Answer 2

fever, chills, respiratory distress (allergic reaction), hyper/hypotension, pain, rash, jaundice, hemoglobinuria, nausea, vomiting

Question 3

reporting deaths

Answer 3

initial report within 24 hrs to the FDA & a report of the investigation within 7 days of the death

Question 4

Hemoviligance program

Answer 4

‘cooperation’ between CDC, hospitals, & AABB for reporting all adverse events

Question 5

hemolytic vs non-hemolytic reaction

Answer 5

hemolytic: immune-mediated or physical/chemical damage to RBCs (freezing)
non-hemolytic: frebrile, allergic, or circulatory overload

Question 6

acute vs delayed reactions

Answer 6

actue: hemolytic reaction (24 hrs): hemolytic, infectious disease, graft v host disease

Question 7

immune-mediated vs nonimmune-mediated reactions

Answer 7

immune: hemolytic transfusion reaction, TRALI, anaphylactic
nonimmune: hemosiderosis (iron overload), citrate toxicity, circulatory overload (TACO)

Question 8

noninfectious vs infectious reactions

Answer 8

noninfectious: leading cause of transfusion related deaths
infectious: rare; bacterial, viral transmission, parasitic

Question 9

acute HTR

Answer 9

intravascular hemolysis accompanied by hgb in the urine & plasma
activation of complement!!!
main reason for death is the shock & renal failure
REQUIRES A PREFORMED ANTIBODY

Question 10

clinical presentation of acute HTR

Answer 10

fever, chills/rigors
hypotension
hemoglobinuria
anuria/oligonuira

Question 11

lab testing for acute HTR

Answer 11

commonly a positive DAT
increase plasma& urine hemoglobin
decreased serum haptoglobin
decreased plts, factors V, VIII, fibrinogen, PT, APTT
increased fibrin degradation products

Question 12

worst ABO incompatibility?

Answer 12

A unit into an O patient

10% mortality

Question 13

clinical presentation of delayed HTR

Answer 13

fever

mild jaundice

Question 14

lab testing for delayed HTR

Answer 14

positive DAT
positive antibody screen following elution
decreased hgb/hct

Question 15

antibody responsible for majority of delayed HTR

Answer 15

Jkb 70%

Question 16

Physical RBC destruction

Answer 16

blood unit exposed to temperatures >50C & >0C
improper thawing!!
incompatible solutions
the hemolyzed donor unit will contain free hgb

Question 17

Febrile transfusion reaction

Answer 17

MOST COMMON TRANSFUSION REACTION
mimics acute HTR so must be careful
DAT NEGATIVE!
cytokines released by WBCs during blood storage

Question 18

TRALI

Answer 18

transfusion-related acute lung injury
severe respiratory distress during/within 6 hours of transfusion
x-ray of lungs show bilateral infiltrates
donor anti-HLA antibodies activate recipient neutrophils in the lungs

Question 19

‘solution’ to TRALi

Answer 19

donor centers do not make FFP from women, policy with platelets from women that have been pregnant is in flux

Question 20

TACO (circulatory overload)

Answer 20

patient’s cardiopulmonary system exceeds its volume capacity
pulmonary edema(!!)
treat with diuretics
transfuse slowly & in small volumes

Question 21

at risk patients for TACO

Answer 21

patients with heart conditions, chronic anemia, & children

Question 22

TACO vs TRALI symptoms

Answer 22

TACO: hypertension, no fever, normal WBC, elevated BNP

TRALI: hypotension, fever, neutropenia, normal BNP

Question 23

Posttransfusion purpura (PTP)

Answer 23

severe thrombocytopenia after plt transfusion

cause: antibody to plt antigen HPA-1 or HLA
treatment: remove antibody from circulation

Question 24

Adverse effects unique to massive transfusions

Answer 24

transfusion hemosiderosis
coagulopathathy
citrate toxicity
hypothermia

Question 25

transfusion reaction work up

Answer 25

compare pre- & post- plasma for hemolysis
perform DAT on pre & post
if positive DAT perform elution