Transfusion Reactions Flashcards by Martha Innes

What is the main blood grouping system?

ABO

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How does ABO system classify blood types?

Based on the antigen expressed and the IgM antibody present in the blood

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In blood group O, what is the genotype, antigens, antibodies, and frequency?

Genotype - OO
Antigens - none
Antibodies - anti-A, anti-B
Frequency - 43%

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In blood group A, what is the genotype, antigens, antibodies, and frequency?

Genotype - AO or AA
Antigens - A
Antibodies - anti-B
Frequency - 45%

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In blood group B, what is the genotype, antigens, antibodies, and frequency?

Genotype - BO or BB
Antigens - B
Antibodies - anti-A
Frequency - 9%

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In blood group AB, what is the genotype, antigens, antibodies, and frequency?

Genotype - AB
Antigens - A and B
Antibodies - none
Frequency - 3%

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How is blood tested for ABO grouping?

Red cell testing - if there is agglutination between patient red cells and an antibody (e.g. anti-A), that means the antigen the antibody is against is expressed (e.g. A antigen)
Plasma testing - if there is agglutination between patient plasma cells and donor red cells of a group (e.g. group B) the patient has antibodies against that group (e.g. anti-B)

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What % of the population is rhesus positive?

85%

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What does it mean to be rhesus positive or negative?

If you’re positive you express the rhesus antigen

If you’re negative you dont

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How is blood tested for Rhesus grouping?

The patient’s blood is Rh-positive if it agglutinates when exposed to anti-D antibody

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What is the significance of rhesus grouping for transplants?

Rh-positive blood cannot be given to Rh-negative patients
This is because rhesus antibodies are produced by Rh-negative people in response to exposure to Rh-positive blood
After sensitisation exposure to Rh-positive blood can result in haemolytic disease

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How are Rh-negative pregnant women treated to prevent haemolytic disease?

Anti-D injection

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What disorders are blood transfusions screened for?

Malignancy
HIV
Hepatitis
Syphilis

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What steps need to be taken when giving a transfusion?

Confirm patient details
Complete transfusion request with either G&S or crossmatch
Check the bag - is it the right patient, is it in date, are there any holes or clots
Double check patient ID and start transfusion

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When are platelets given?

Thrombocytopenia

DIC

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When is fresh frozen plasma given?

DIC

Warfarin overdose

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When is cryoprecipitate given?

Same as FFP but contains factors VIII/IX, vWF so preferred if specific factors needed

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When is prothrombin complex given?

Bleeding in vit K deficiency - warfarin, liver disease

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What are the symptoms of acute transfusion reactions?

Chills
Rigors
Rash
Flushing
Feeling of impending doom
Collapse
Loin pain
Respiratory distress

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What are the signs of acute transfusion reactions?

Fever
Tachycardia
Hypotension

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What actions should be taken in all transfusion reactions?

Stop the transfusion
ABCDE assessment
Re-check compatibility tag against patient details and inspect pack for evidence of contamination
Document event in medical notes

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What are signs of severe or life-threatening transfusion reaction?

Evidence of life-threatening airway, breathing or circulation problem
Evidence of wrong component transfused or bacterial contamination

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What is the immediate management when a severe or life-threatening transfusion reaction is suspected?

Seek senior medical advice
Resuscitate patient
Return compartment to transfusion lab to allow further investigations

What is an acute haemolytic transfusion reaction?

ABO mismatch transfusion

What is the pathophysiology of acute haemolytic transfusion reaction?

IgM mediated reaction against transfused cells Patient IgM anti-A or -B antibodies bind to the corresponding antigens in the donor bag resulting in complement activations and intravascular haemolysis of transfused cells Release of inflammatory cytokines - complement, kinin, coagulation systems Shock, increased vascular permeability, DIC, renal failure

What is the presentation of an acute haemolytic transfusion reaction?

``` Fever Flushing Hypotension and tachycardia Generalised severe pain - chest, abdomen Oozing of blood out of cannulation site (DIC) Onset as soon as transfusion starts ```

What is the management of an acute haemolytic transfusion reaction?

Stop transfusion, return unit to lab, inform lab, check patient and bag identity Supportive - oxygen, fluids Repeat transfusion blood samples Take bloods - FBC, coat screen, renal function, LDH, blood cultures

Which type of unit is bacterial contamination more common with?

Platelets

How can a bacterial contamination transfusion reaction be prevented?

Examination of the transfused unit for clots

What is the presentation of a bacterial contamination transfusion reaction?

Fever Rigors Hypotension

What is the management of a bacterial contamination transfusion reaction?

Culture patient and remains of unit Treat supportively and with broad spectrum antibiotics Inform transfusion lab for quarantine of other units

What is an anaphylaxis transfusion reaction?

IgE mediated allergic reaction to plasma proteins in the transfuswion

What is the presentation of an anaphylaxis transfusion reaction?

Hypotension Mucosal swelling Airway obstruction - stridor, desaturation

When is an anaphylaxis transfusion reaction more common?

IgA desaturation

What is the management of an anaphylaxis transfusion reaction?

``` ABCDE guidelines - O2 and fluid challenge Adrenaline 0.5mls IM Hydrocortisone 200mg IV Chlorphenamine 10mg IV Get the anaesthetist ```

What is transfusion associated circulatory overload?

A transfusion reaction that occurs due to a rapid transfusion of a large volume of blood Results in cardiopulmonary oedema Caused by an inability of the recipient to compensate fro the transfused volume

What is the presentation of transfusion associated circulatory overload?

Respiratory distress within 6 hours of transfusion Raised blood pressure Raised JVP Positive fluid balance

What are the risk factors for transfusion associated circulatory overload?

``` Elderly Cardiac failure Low albumin Renal impairment Fluid overload ```

What is the management of transfusion associated circulatory overload?

Oxygen and supportive care as required Diuretics Consider slowing rate of further transfusions Consider diuretics with future transfusion Only transfuse minimum volume required

How can transfusion associated circulatory overload be prevented?

Identify patients at risk before first transfusion

What is transfusion related acute lung injury?

Acute respiratory distress syndrome that is caused by anti-leucocyte antibodies in the transfused plasma

What is the presentation of transfusion related acute lung injury?

``` Previously fit and well patient Shortness of breath Cough Tachypnoea Bilateral crepitations ```

How is transfusion related acute lung injury diagnosed?

Clinical signs | Plus CXR - white out

What is the management of transfusion related acute lung injury?

Oxygen Admission to ITU Source identified and removed from the register

What is a mild transfusion reaction?

Isolated temperature rise to >38 and rise of 1-2 degrees or rash only

What is the management of a mild transfusion reaction?

Continue transfusion - consider slowing rate Close monitoring of patient in case condition worsens Consider paracetamol/anti-histamine

What is the presentation of a febrile non-haemolytic transfusion reaction?

Presents about 30 minutes after starting transfusion Five igors

What is a mild allergic transfusion reaction?

IgE mediated reactions to plasma proteins in the transfusion

What is the presentation of a mild allergic transfusion reaction?

Rash/itch but with normal observations

What is the treatment of a mild allergic transfusion?

Anti-histamines (chloramphenamine)

What is a delayed haemolytic transfusion reaction?

Patient mounts delayed immune response to red cell antigen - usually IgG Extravascular haemolysis 5-10 days post-transfusion

Who more commonly get a delayed haemolytic transfusion reaction?

Patients who have had previous transfusions

What is the presentation of a delayed haemolytic transfusion reaction?

5-10 days after transfusion | Jaundice

What do investigations show in a delayed haemolytic transfusion reaction?

Positive Coomb's test Sudden drop in Hb Raised bilirubin, LDH AKI

What is the management of a delayed haemolytic transfusion reaction?

Slow or stop transfusion Anti-pyretic - paracetamol Close monitoring If recurrent - whit cell depleted transfusions