Transfusion Effects and Cases

Question 1

Below are examples of:
• Hemolytic transfusion reactions
• Febrile Non-hemolytic reactions
• Hives and other allergic reactions
• Transfusion related acute lung injury (TRALI)

Answer 1

Immediate Immunologic reactions to Transfusions

Question 2

Below are examples of:
• Transfusion-associated circulatory overload
• Bacterial Contamination
• Massive transfusion effect

Answer 2

Immediate Non-immunolgic reactions to Transfusions

Question 3

Below are examples of:
• Delayed hemolytic transfusion reaction
• Post transfusion purpura
• Post transfusion graft vs host disease

Answer 3

Delayed immunologic reactions to Transfusion

Question 4

These are examples of:
• Infectious diseases
• Fe overload

Answer 4

Delated non-immunologic effects of transfusion

Question 5

The majority of transfusios have no complications, when it does, its more often then not:

Answer 5

Allergic or Fever (not overconcerning)

Other stuff can be SUPER bad though

Question 6

High mortatlity related adverse effects of transfusion

Answer 6

TRALI
TACO
HTR

Question 7

Quantitative risks of Transfusion
TRALI
Delayed HTR
Acute hemolytic Rxn

Answer 7

TRALI: 1:5,000
Delatey HTR: 1:1,000
Acute hemolytic rxn: 1:250,000
**bacterial and viral not as commong

Question 8

Transfusion Related Fever

Differential Diagnosis

Answer 8

• FNHTR
• Hemolytic Transfusion Reaction
• Bacterial Contamination
• TRALI
• Allergic Reaction
• Related to underlying Disease in Patient

Question 9

• Febrile non-hemolytic transfusion reaction
(FNHTR)
– Antibodies in recipient to \_\_\_\_\_\_\_\_
• BRM from Donor WBC
• Activation of :

Answer 9

donor WBC

recipient macrophages-endogenous BRM’s

Question 10

How often do we see FNHTR?

When do we see it?

Answer 10

1:200 transfusions or 6-10%

occurs at END of transfusion (not during)

Question 11

Signs and symptoms of FNHTR

Answer 11

– Fever (at least 1° C elevation)
– Chills/rigors
– Hypertension
– Rapid heart rate
– Shortness of breath

Question 12

The accelerated clearance of red blood cells in a
transfusion recipient due to immunologic
incompatibility between the blood donor and the
recipient

Answer 12

Hemolytic Transfusion Reactions

Question 13

Two examples of Acute Hemolytic rxns

Answer 13

ABO errors

Intravascular hemolysis

Question 14

Acute Hemolytic Rxn:
Extra or Intravascular?
Cause?

Answer 14

Acute hemolytic rxn is INTRAvascular d/t ABO error~ happens 1-2 horus

Question 15

Delayed hemolytic reactions:
Extra or Intravascular?
Cause?

Answer 15

Delayed hemolytic rxn are EXTRAvascular and d/t undetected antibody at XM

Question 16

Signs and symptoms of Acute hemolytic transfusion rxns?

Answer 16

fever, chills

anxiety, flank/back pain, flushed, diffuse bleeding, hyer or hypotension

Question 17

• Anaphylactic reaction
• Anaphalactoid reaction
• Allergic reaction
• Urticarial reaction

Answer 17

All IgE mediated reactions: hives, wheezing, rash, SOB

Question 18

IgE rxn symptoms
Cutaneous:
Respiratory:
GI:
CV:

Answer 18

IgE reactions
Signs and Symptoms
• Cutaneous: Pruritis, Urticaria, Flushing, angioedema
• Respiratory: Bronchospasm, wheezing, stridor,
chest tightness, chest pain, dyspnea, cyanosis
• Gastrointestinal: Nausea, vomiting, diarrhea, abdominal cramps
• Cardiovascular: Hypotension, shock, tachycardia, arrhythmias/arrest

Question 19

– Pulmonary edema without heart failure
– Adult Respiratory Distress Syndrome (ARDS)
– Hypoxemia, Cyanosis
– Tachycardia, hypotension
– Fever
– pO2

Answer 19

Transfusion-Induced Acute Lung Injury

TRALI

Question 20

Signs and Symptoms Of TRALI almost
always occur within___ hours of transfusion
and most within__ hours.

Answer 20

6

2

Question 21

Pathophysiology of TRALI

• Antibody mediated: explain
• Two hit hypothesis: explain

Answer 21

Pathophysiology
– Antibody mediated
• HLA antibodies
• Neutrophil specific antibodies
– Two hit hypothesis
• First hit – surgery, sepsis, etc.
• Second hit – neutrophil priming factor
(lysophosphatidylcholines, CD40L)

Question 22

Preventitive measures against TRALI

Answer 22

FFP manufactured only from males and
females with no history of prior pregnancy
Single Donor Apheresis Platelets and Apheresis
Plasma collected from males and females
screened negative for antibodies to HLA antigens

Question 23

Graft Vs Host Disease (GVHD)

• Cause:

Answer 23

Immunocompetent lymphocytes in donor

blood recognize the recipient as “foreign

Question 24

Cause of GVHD in transfusion:
Recipient’s immune system cannot recognize and/or
react to the donor’s immune cells because of:

Answer 24

– Similarity in HLA antigen types

– Recipient is immunosuppressed

Question 25

• Signs and symptoms of Transfusion induced GVHD

: all cases are ACUTE

Answer 25

– High fever followed by diffuse rash about 3 weeks
after the transfusion
– Nausea/vomiting/watery diarrhea
– Liver damage
– Pancytopenia (distinguishes transfusion induced
GVHD from post BMT GVHD)
– Mortality: greater than 90%

Question 26

– High fever followed by diffuse rash about 3 weeks
after the transfusion
– Nausea/vomiting/watery diarrhea
– Liver damage
– Pancytopenia (distinguishes transfusion induced
GVHD from post BMT GVHD)
– Mortality: greater than 90%

Answer 26

Transfusion induced GVHD

Question 27

Who is at highest risk for Transfusion induced GVHD

Answer 27

– Severe combined immunodeficiency syndrome(SCID)
– Bone marrow transplant recipients
– Fetus or neonate
– Patients receiving high dose chemotherapy
(leukemia/lymphoma)