Transfusion Reactions Flashcards
What is the main blood grouping system?
ABO
How does ABO system classify blood types?
Based on the antigen expressed and the IgM antibody present in the blood
In blood group O, what is the genotype, antigens, antibodies, and frequency?
Genotype - OO
Antigens - none
Antibodies - anti-A, anti-B
Frequency - 43%
In blood group A, what is the genotype, antigens, antibodies, and frequency?
Genotype - AO or AA
Antigens - A
Antibodies - anti-B
Frequency - 45%
In blood group B, what is the genotype, antigens, antibodies, and frequency?
Genotype - BO or BB
Antigens - B
Antibodies - anti-A
Frequency - 9%
In blood group AB, what is the genotype, antigens, antibodies, and frequency?
Genotype - AB
Antigens - A and B
Antibodies - none
Frequency - 3%
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)
What % of the population is rhesus positive?
85%
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
How is blood tested for Rhesus grouping?
The patient’s blood is Rh-positive if it agglutinates when exposed to anti-D antibody
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
How are Rh-negative pregnant women treated to prevent haemolytic disease?
Anti-D injection
What disorders are blood transfusions screened for?
Malignancy
HIV
Hepatitis
Syphilis
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
When are platelets given?
Thrombocytopenia
DIC
When is fresh frozen plasma given?
DIC
Warfarin overdose
When is cryoprecipitate given?
Same as FFP but contains factors VIII/IX, vWF so preferred if specific factors needed
When is prothrombin complex given?
Bleeding in vit K deficiency - warfarin, liver disease
What are the symptoms of acute transfusion reactions?
Chills Rigors Rash Flushing Feeling of impending doom Collapse Loin pain Respiratory distress
What are the signs of acute transfusion reactions?
Fever
Tachycardia
Hypotension
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
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
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
