Transfusion Effects and Cases Flashcards
Below are examples of: • Hemolytic transfusion reactions • Febrile Non-hemolytic reactions • Hives and other allergic reactions • Transfusion related acute lung injury (TRALI)
Immediate Immunologic reactions to Transfusions
Below are examples of:
• Transfusion-associated circulatory overload
• Bacterial Contamination
• Massive transfusion effect
Immediate Non-immunolgic reactions to Transfusions
Below are examples of:
• Delayed hemolytic transfusion reaction
• Post transfusion purpura
• Post transfusion graft vs host disease
Delayed immunologic reactions to Transfusion
These are examples of:
• Infectious diseases
• Fe overload
Delated non-immunologic effects of transfusion
The majority of transfusios have no complications, when it does, its more often then not:
Allergic or Fever (not overconcerning)
Other stuff can be SUPER bad though
High mortatlity related adverse effects of transfusion
TRALI
TACO
HTR
Quantitative risks of Transfusion
TRALI
Delayed HTR
Acute hemolytic Rxn
TRALI: 1:5,000
Delatey HTR: 1:1,000
Acute hemolytic rxn: 1:250,000
**bacterial and viral not as commong
Transfusion Related Fever
Differential Diagnosis
- FNHTR
- Hemolytic Transfusion Reaction
- Bacterial Contamination
- TRALI
- Allergic Reaction
- Related to underlying Disease in Patient
• Febrile non-hemolytic transfusion reaction (FNHTR) – Antibodies in recipient to \_\_\_\_\_\_\_\_ • BRM from Donor WBC • Activation of :
donor WBC
recipient macrophages-endogenous BRM’s
How often do we see FNHTR?
When do we see it?
1:200 transfusions or 6-10%
occurs at END of transfusion (not during)
Signs and symptoms of FNHTR
– Fever (at least 1° C elevation) – Chills/rigors – Hypertension – Rapid heart rate – Shortness of breath
The accelerated clearance of red blood cells in a
transfusion recipient due to immunologic
incompatibility between the blood donor and the
recipient
Hemolytic Transfusion Reactions
Two examples of Acute Hemolytic rxns
ABO errors
Intravascular hemolysis
Acute Hemolytic Rxn:
Extra or Intravascular?
Cause?
Acute hemolytic rxn is INTRAvascular d/t ABO error~ happens 1-2 horus
Delayed hemolytic reactions:
Extra or Intravascular?
Cause?
Delayed hemolytic rxn are EXTRAvascular and d/t undetected antibody at XM
Signs and symptoms of Acute hemolytic transfusion rxns?
fever, chills
anxiety, flank/back pain, flushed, diffuse bleeding, hyer or hypotension
- Anaphylactic reaction
- Anaphalactoid reaction
- Allergic reaction
- Urticarial reaction
All IgE mediated reactions: hives, wheezing, rash, SOB
IgE rxn symptoms Cutaneous: Respiratory: GI: CV:
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
– Pulmonary edema without heart failure – Adult Respiratory Distress Syndrome (ARDS) – Hypoxemia, Cyanosis – Tachycardia, hypotension – Fever – pO2
Transfusion-Induced Acute Lung Injury
TRALI
Signs and Symptoms Of TRALI almost
always occur within___ hours of transfusion
and most within__ hours.
6
2
Pathophysiology of TRALI
- Antibody mediated: explain
- Two hit hypothesis: explain
Pathophysiology – Antibody mediated • HLA antibodies • Neutrophil specific antibodies – Two hit hypothesis • First hit – surgery, sepsis, etc. • Second hit – neutrophil priming factor (lysophosphatidylcholines, CD40L)
Preventitive measures against TRALI
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
Graft Vs Host Disease (GVHD)
• Cause:
Immunocompetent lymphocytes in donor
blood recognize the recipient as “foreign
Cause of GVHD in transfusion:
Recipient’s immune system cannot recognize and/or
react to the donor’s immune cells because of:
– Similarity in HLA antigen types
– Recipient is immunosuppressed
• Signs and symptoms of Transfusion induced GVHD
: all cases are ACUTE
– 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%
– 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%
Transfusion induced GVHD
Who is at highest risk for Transfusion induced GVHD
– Severe combined immunodeficiency syndrome(SCID)
– Bone marrow transplant recipients
– Fetus or neonate
– Patients receiving high dose chemotherapy
(leukemia/lymphoma)
