Transfusion reactions Flashcards
What are transfusion reactions
Adverse events associated with transfusion of whole blood or one of its components
What are the two main groups of transfusion reactions?
Immediate
Delayed
What are immediate transfusion reactions further classified into?
Immune
Non-immune
Give the immune mediated immediate transfusion reaction causes
Acute haemolytic transfusion reaction (ABO incompatibility)
Transfusion-related acute lung injury (TRALI)
Anaphylaxis
Give the non-immune mediated immediate transfusion reaction causes
Bacterial infection
Transfusion-associated circulatory overload (TACO)
What are the signs of TACO?
Acute/worsening respiratory compromise and/or worsening pulmonary oedema up to 12 hours after transfusion
Give the immune mediated delayed transfusion reaction causes
Delayed haemolytic transfusion reaction (DHTR)
Febrile non-haemolytic transfusion reaction (FNHTR)
Post-transfusion purpura (PTP)
Graft versus host disease (GvHD)
Give the non-immune mediated delayed transfusion reaction causes
Viral infections
Malaria
Prion
What is an acute haemolytic transfusion reaction?
ABO incompatibility
Results in anti-A/B antibodies activating the complement pathway and triggering the release of inflammatory cytokines
What are the early clinical features of an acute haemolytic transfusion reaction?
Fever
Hypotension
Anxiety
Red-coloured urine
What are the late clinical features of an acute haemolytic transfusion reaction?
Hypotension
Widespread haemorrhage secondary to disseminated intravascular coagulation (DIC)
What is transfusion-related acute lung injury (TRALI)?
Pathophysiology not fully understood
Antibodies in the donor blood to human neutrophil antigens and HLA in recipient’s blood have been implicated
What is the typical presentation of TRALI?
Sudden dyspnoea
Severe hypoxaemia
Hypotension
Fever within 6 hours after transfusion
How long does it take a TRALI to resolve with supportive care?
48 - 96 hours
What is anaphylaxis in a transfusion reaction?
Recipient has allergy to protein components present in the donor transfusion
Develops over minutes to hours
Can quickly become life-threatening
What are the typical clinical features of anaphylaxis in a transfusion reaction?
Itchy rash
Angioedema
SOB
Vomiting
Lightheadedness
Hypotension
What is a delayed haemolytic transfusion reaction (DHTR)?
Caused by antibodies to antigens such as Rhesus or Kidd
How many days after the transfusion can DHTR occur?
3 - 14 days
What are the typical clinical features of DHTR?
Sudden drop in Hb
Fever
Jaundice
Haemoglobinuria
What is febrile non-haemolytic transfusion reaction (FNHTR)?
Most commonly caused by antibodies directed against donor leukocytes and HLA antigens
In contrast to TRALI in which the donor plasma has antibodies against the recipient HLA antigens
What are the typical clinical features of FNHTR?
Fever during blood transfusion
No associated haemolysis
Which group of people are more likely to get FNHTR?
Patients who have received multiple transfusions
Multigravidous women
What is post-transfusion purpura (PTP)?
An adverse reaction to a blood transfusion or platelet transfusion that occurs when the body produces alloantibodies to the introduced platelets’ antigens
Alloantibodies destroy the patient’s platelets leading to thrombocytopenia
How many days after a transfusion does PTP present?
5 - 12 days
What is graft versus host disease (GvHD)?
Medical complications after the receipt of transplanted tissue from a genetically different individual
Immune cells (WBCs) in the donated tissue (the graft) recognise the recipient (the host) as foreign (nonself)
The transplanted immune cells then attack the host cells
Why could GvHD occur after a blood transfusion?
If the blood products used have not be irradiated or treated with an approved pathogen reduction system
Which of the blood products is more likely to have bacterial contamination and why?
Platelet transfusion - stored at room temperature between 20-24ºC as too cold temperatures lead to damage to the platelet membranes but warmer temperatures are much more favourable for bacterial contamination and growth, compared to products stored at colder temperatures.
Red blood cells are stored at temperatures between 2-6ºC. Fresh frozen plasma and cryoprecipitate are stored at temperatures of -30ºC and are thawed just before use. These temperatures make bacterial contamination much less likely.
Fibrinogen is now commonly stored as a powder that is mixed into a solution with sterile water. Therefore, it is unlikely to cause bacterial contamination.
Sources
https://geekymedics.com/blood-transfusion-osce-guide/
https://www.ncbi.nlm.nih.gov/books/NBK482202/ (Transfusion reaction)
https://www.passmedicine.com/v7/question/questions.php?q=0
