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Clinical Chem > Transfusion Reactions > Flashcards

Transfusion Reactions Flashcards

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1
Q

Acute Immune Reactions

A 
Hemolytic
Febrile, Non-Hemolytic
Urticarial
Anaphylactic
Transfusion-Related Acute Lung Injury (TRALI)
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2
Q

Acute Non-Immune Reaction

A 
Transfusion-Associated Bacterial Sepsis
Hypotension associated with ACE inhibition
Circulatory Overload
Non-Immune Hemolysis
Air Embolus
Hypocalcemia
Hypothermia
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3
Q

Delayed Immune Reaction

A 
Alloimmunization, RBC antigens
Hemolytic
Alloimmunization, HLA antigens
Graft-Vs-Host-Disease
Post-Transfusion Purpura
Immunomodulation
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4
Q

Delayed Non-Immune Reaction

A

Iron Overload (> 100 RBC units)

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5
Q

Acute Hemolytic Transfusion Reaction Causes

A 
Causes:
pre-formed Abs in recipient interact w/ transfused RBCs
plasma containing high-titer ABO Abs
Usually ABO incompatibility
Occasionally Rh and Kidd Abs
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6
Q

Acute Hemolytic Transfusion Reaction Complement Activation

A

Complement activation:
RBCs coated with C3b are phagocytized by WBCs
MAC: intravascular hemolysis by production of C5

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7
Q

Acute Hemolytic Transfusion Reaction Symptoms

A 
Fever, 
chills, 
hemoglobinuria, 
wheezing, 
chest pain, 
abdominal pain, 
oozing at surgical site during surgery, 
hypotension, 
bronchospasm
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8
Q

Acute Hemolytic Transfusion Reaction Coagulation Effects

A

Activation of intrinsic pathway by factor XII
Tissue factor activates extrinsic pathway causing DIC and hemorrhagic susceptibility
Activated Factor XII -> Bradykinin -> hypotension and shock

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9
Q

Acute Hemolytic Transfusion Reaction Cytokine Effects

A

Fever
Hypotension
Pro-coagulant activity of endothelial cells
Activation of neutrophils and platelets

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10
Q

Acute Hemolytic Transfusion Reaction Treatment

A

Hypotension: IV normal saline, avoid overhydration (use pressors)
Maintain open air way and heart rate
Maintain adequate renal blood flow through diuretics (furosemide)
Consumptive coagulopathy: platelets, FFP, cryo

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11
Q

Acute Hemolytic Transfusion Reaction Prevention

A

Proper patient ID (clerical error is most common AHTR cause)
Prevent human clerical error
Train staff to recognize AHTR and stop transfusion before critical volume of blood administered
No method is fool-proof

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12
Q

Febrile, Non-Hemolytic Reaction Characteristics

A

Most frequent adverse reaction
Temperature ≥ 1 C above 37 C
Usually benign but must distinguish between fever due to transfusion or other illness
Associated with chills, rigors, mild dyspnea

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13
Q

Febrile, Non-Hemolytic Reaction Causes

A 
Abs in recipient against donor HLA Ags (lymphocytes, granulocytes, platelets)
Previous alloimmunization (pregnancy, multiple transfusions) increase frequency/risk
Cytokine release in recipient following Ab-Ag interaction
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14
Q

Febrile, Non-Hemolytic Reaction Treatment

A

Discontinue transfusion (reinstate if appropriate)
Antipyretics (acetaminophen) for fever
Meperidine for chills

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15
Q

Febrile, Non-Hemolytic Reaction Prevention

A

Transfuse leuko-reduced blood product
Transfuse platelets ≤ 3 days old when non-LR platelets available
Plasma removal
Pre-medicate recipient with antipyretics (acetaminophen)

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16
Q

Allergic Reactions Characteristics

A

Mild to severe
Mild: urticarial reactions
Severe: anaphylaxis (within minutes of transfusion) is seen more in platelet and plasma transfusions

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17
Q

Allergic Reactions Symptoms

A

NO FEVER
Skin: urticaria (flushing or rash), localized swelling (angioedema)
Respiratory: cough, hoarseness, stridor, wheezing, chest tightness/pain, dyspnea
Gastrointestinal tract: cramps, nausea, vomiting, diarrhea
Circulatory system: tachycardia, other arrhythmias, cardiac arrest

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18
Q

Allergic Reactions Causes

A

Interaction of donor plasma substance binding to IgE of mast cells -> activated mast cells release histamine
Anti-IgA Abs in recipients that are IgA deficient
Allergies to sterilizers, preservatives, coagulating components in drug products

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19
Q

Allergic Reactions Treatment

A

For mild symptoms:
Temporarily interrupt transfusion
Administer antihistamines (benadryl)
If symptoms resolve, transfusion may be resumed

For anaphylaxis:
Stop transfusion
Trendelenburg position (feet up in the air)
EPINEPHRINE
OXYGEN THERAPY
Intubation if significant upper respiratory obstruction
Vasopressors (dopamine)

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20
Q

Allergic Reactions Prevention

A

Mild symptoms:
Diphenhydramine 1 hour before transfusion
If premedication unsuccessful, then washed RBCs and platelets

For patients with anaphylaxis history or IgA deficiency with anti-IgA Abs:
Transfuse washed product or IgA-deficient products
Autologous units for patients with prior anaphylaxis

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21
Q

Transfusion-Related Acute Lung Injury (TRALI) Characteristics

A

New Lung Injury within 6 hours of transfusion and no other associated acute lung injury factors
- Usually after transfusion of plasma-containing components

22
Q

Transfusion-Related Acute Lung Injury (TRALI) Symptoms

A

Acute respiratory insufficiency with hypoxemia and x-ray shows bilateral pulmonary edema
Normal central venous pressure
Fever, chills, hypotension in 1 or 2 hours of transfusion

23
Q

Transfusion-Related Acute Lung Injury (TRALI) Causes

A

Donor Abs against recipient HLA Ags
- causes increase pulmonary permeability -> fluid enters pulmonary interstitium and alveolar space
Recipient Abs against donor HLA Ags

24
Q

Transfusion-Related Acute Lung Injury (TRALI) Treatment

A

Stop transfusion
Oxygen therapy and ventilator assistance
Recovery usually 24-96 hours, death ≤10%

25
Q

Transfusion-Related Acute Lung Injury (TRALI) Prevention

A

Donor whose Abs caused TRALI -> not allowed to donate again
Females with previous pregnancies not to able to donate plasma or platelets
- AABB regulation to reduce exposure of leukocyte-alloimmunization

26
Q

Immune-related hemolysis not related to specific RBC Ags

A

Patients with CAD can hemolyze cold RBCs
Paroxysmal Nocturnal Hemoglobinuria (complement activation hemolyzes transfused RBCs)
AIHA caused by auto-Abs

27
Q

Thermal Injury

A 
Heat Injury:
- RBC membrane injured in temp > 40 C
Cold injury:
- below-freezing temps w/o cryoprotective agent
- rapidly frozen-thawed RBCs
28
Q

Mechanical Hemolysis

A

Cardiac surgery, cardiac valves, dialysis, apheresis
Pressure infusion pumps, pressure cuffs
Small-bore needles

29
Q

Osmotic Hemolysis

A

Drugs and hypotonic solutions:

  • hypotonic solutions enter circulation
  • inadequately deglycerolized RBCs
  • Ca 2+ in lactated ringer’s chelates citrate in anticoag/preservatives -> clot formation
30
Q

Chemical drugs

A

Acute lead and copper toxicity

Drugs leading to oxidant stress

31
Q

Donor with congenital hemolytic anemia

A

RBCs from donor with G-6-PD deficiency lyse in recipient when exposed to oxidant stress
Shortened RBC lifespan due to sickle cell trait donors

32
Q

Transfusion-Associated Sepsis

A

Examine blood products for particulate matter, clots, gross hemolysis, change in color, gas bubbles
May be severe; death associated with gram neg bacilli

33
Q

Transfusion-Associated Symptoms

A 
Fever! Usually very high
Chills, rigors
Abdominal pain
Shock
Renal failure
DIC
Death in severe cases
34
Q

Transfusion-Associated Evaluation and Treatment

A

Collect blood cultures, gram stain and blood culture

If infection suspected -> begin broad-spectrum antibiotics

35
Q

Transfusion-Associated Prevention

A

Use of aseptic technique in transfusion process
Maintain storage temps
Perform visual inspection
Bacterial testing for platelets

36
Q

Transfusion-Associated Circulatory Overload (TACO) Characteristics

A

Acute pulmonary edema due to volume overload
- rapid increase in plasma volume poorly tolerated in patients with compromised pulmonary/cardiac status and those with chronic anemia
Young children and elderly most vulnerable

37
Q

Transfusion-Associated Circulatory Overload (TACO) Symptoms

A

Dyspnea, cyanosis, orthopnea, tachycardia, severe headache, hypertension, CHF associated w/transfusion, pulmonary edema
Elevated central venous pressure
Elevated levels of brain natriuretic peptide (BNP) may be seen

38
Q

Transfusion-Associated Circulatory Overload (TACO) Treatment

A

Stop transfusion
Place patient in a sitting position
Diuretics
Oxygen therapy

39
Q

Transfusion-Associated Circulatory Overload (TACO) Prevention

A

Slow transfusion
Diuretics before and during transfusion helpful
If transfusion to exceed 4 hours, Blood Bank can provide smaller, split units

40
Q

Transfusion Associated Dyspnea (TAD)

A

Perceived as clinically milder than TRALI/TACO

41
Q

Air Embolism Symptoms, Treatment, Prevention

A

Minimum volume of potentially fatal air embolism for adults is 100 mL
Symptoms
- cough, dyspnea
- chest pain and shock
Treatment
- place patient on the left side with head down
Prevention
- proper use of infusion pumps, equipment for blood recovery or apheresis, and tubing couplers

42
Q

RBC Primary alloimmunization

A

Newly formed Abs to RBC Ags weeks-months after transfusion

Abs can subsequently become undetectable (Kidd, Rh)

43
Q

RBC Secondary alloimmunization

A

RBCs w/corresponding Ag given
IgG Abs react w/RBCs w/in hrs-days of transfusion (3-21 days)
Not all secondary responses lead to hemolysis

44
Q

RBC Alloimmunization Serological Presentation

A

Abs in patient serum
Abs on donor’s RBCs (pos DAT only)
- Elution necessary to ID Ab bound to RBCs

45
Q

RBC Alloimmunization Treament

A

Transfuse donor RBCs lacking Ag(s) in question
Monitor patient’s renal function and coagulation status
Monitor lab results

46
Q

Alloimmunization to HLA

A

Anti-HLA Abs detected by platelet antibody screen, lymphocytotoxicity test, flow cytometry
Prevention:
- Avoid unnecessary transfusions
- Use leukocyte-reduced blood

47
Q

Graft-Vs-Host Disease (GVHD) Cause, Symptoms, Pathology

A

Cause: engraftment and proliferation of donor T cells in susceptible host
Pathology: Attack recipient’s lymphoid tissues (BM, skin, liver, GI dysfunction); High mortality: 80-90%
Symptoms: fever, rash, hepatitis, enterocolitis, cough, pancytopenia

48
Q

Graft-Vs-Host Disease (GVHD) Risk Factors

A

Immunodeficiency in recipient (EXCEPT HIV/AIDS PATIENTS)
HLA similarity between donor and recipient
- Recipient heterozygous for HLA haplotype for which donor is homozygous

49
Q

Graft-Vs-Host Disease (GVHD) Prevention

A

Irradiation

Storage time for IRR RBC components = 28 days from IRR or expiration date, whichever is soonest

50
Q

Post-Transfusion Purpura Characteristics and Cause

A

Severe thrombocytopenia due to destruction of patient’s own platelets
Recipient lacks HPA-1a (PlA1) antigen; forms Ab through pregnancy or prior transfusion
Platelet count < 10,000/uL
Self-limiting, recovery w/in 21 days

51
Q

Post-Transfusion Purpura Treatment

A

IVIG is preferred therapy
Plasmapheresis
Transfusion of Ag-negative platelets may not be effective
Ag-negative platelets may be destroyed
Transfuse washed cells or HPA-1a negative cells

52
Q

Iron Overload

A

Delayed, non-immune reaction
Caused by exposure to >50-100 RBC units in a non-bleeding patient
Iron excess interferes with heart, liver and endocrine organs
Treatment:
- Iron-chelator (desferrioxamine)
- Red cell exchange in patients with hemoglobinopathies

Clinical Chem (2 decks)

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