Transfusion reactions Flashcards

1
Q

What causes a non-haemolytic febrile transfusion reaction?

A

alloimmunised recipient produces cytokines due to donor leukocytes/HLA antigens

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2
Q

Clinical features of a non-haemolytic febrile transfusion reaction

A

shivering, fever, +/- headache
nausea
flushing
tachycardia
usually 30-60 mins after starting transfusion
(patient hot but well, most common reaction)

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3
Q

Management of non-haemolytic febrile transfusion reaction

A

slow transfusion
monitor frequently
paracetamol

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4
Q

What antibody mediated an acute haemolytic reaction/ABO incompatibility?

A

IgM

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5
Q

Clinical features of an acute haemolytic reaction/ABO incompatibility

A

fever
hypotension
agitation
flushing
abdominal/chest pain
bleeding/DIC/AKI
patient is very unwell
occurs within minutes of starting transfusion

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6
Q

Acute haemolytic reaction/ABO incompatibility management

A

stop transfusion
supportive management
ABCDE

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7
Q

Bacterial contamination clinical features

A

fever
hypotension
rigors (–> septic shock)

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8
Q

Bacterial contamination management

A

stop transfusion
treat as sepsis (broad spectrum antibiotics)

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9
Q

Delayed haemolytic reaction clinical features

A

anaemia
jaundice
haemoglobinuria

usually 4-8 days (can be up to 4 weeks) after transfusion

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10
Q

Delayed haemolytic reaction management

A

investigations
monitor renal function
specific treatment rarely required

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11
Q

Clinical features of transfusion-related acute lung injury (TRALI)

A

acute respiratory distress syndrome
dyspnoea
cough
CXR whiteout
usually <6 (around 2) hours after transfusion

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12
Q

Clinical features of fluid overload (TACO - transfusion-associated circulatory overload)

A

dyspnoea
hypoxia
tachycardia
increased JVP (jugular venous pulse)
basal crepitations

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13
Q

TRALI management

A

stop transfusion if ongoing
supportive care
ABCDE
oxygen
ICU

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14
Q

Fluid overload management

A

stop transfusion
treat as acute LVF (left ventricular failure):
- furosemide
- oxygen

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15
Q

What can help distinguish between TRALI and fluid overload/TACO?

A

TRALI more likely if severe or no history of LVF
overload more likely if LVF history present

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16
Q

Which antibody mediated anaphylaxis?

A

IgA

17
Q

Clinical features of anaphylaxis

A

bronchospasm
cyanosis
hypotension
soft tissue swelling

18
Q

Anaphylaxis management

A

stop transfusion
treat as anaphylaxis:
- IM adrenaline
- maintain airway
- call anaesthetist

19
Q

What causes allergic reactions in blood transfusions?

A

plasma protein incompatibility

20
Q

Clinical features of allergic reactions

A

urticaria
itch

21
Q

Management of allergic reactions

A

stop or slow transfusion depending on severity
chlorpheniramine (anti-histamine)

22
Q

What causes transfusion-associated graft-versus-host disease?

A

lymphocyte contamination of transfusion product
immune response against recipient cells

23
Q

Symptoms of transfusion-associated graft-versus-host disease

A

rash
pyrexia
diarrhoea
deranged LFTs
bone marrow aplasia

24
Q

How can transfusion reactions be prevented?

A

cross-matching and serologic cross-matching
infection screening questionnaire
infection screening tests on all collected samples
grouping - ABO + Rh status
antibody screening
cytomegalovirus negativity
irradiated red cells
consider alternatives to transfusion