Transfusion reactions

Question 1

What are transfusion reactions

Answer 1

Adverse events associated with transfusion of whole blood or one of its components

Question 2

What are the two main groups of transfusion reactions?

Answer 2

Immediate

Delayed

Question 3

What are immediate transfusion reactions further classified into?

Answer 3

Immune

Non-immune

Question 4

Give the immune mediated immediate transfusion reaction causes

Answer 4

Acute haemolytic transfusion reaction (ABO incompatibility)

Transfusion-related acute lung injury (TRALI)

Anaphylaxis

Question 5

Give the non-immune mediated immediate transfusion reaction causes

Answer 5

Bacterial infection

Transfusion-associated circulatory overload (TACO)

Question 6

What are the signs of TACO?

Answer 6

Acute/worsening respiratory compromise and/or worsening pulmonary oedema up to 12 hours after transfusion

Question 7

Give the immune mediated delayed transfusion reaction causes

Answer 7

Delayed haemolytic transfusion reaction (DHTR)

Febrile non-haemolytic transfusion reaction (FNHTR)

Post-transfusion purpura (PTP)

Graft versus host disease (GvHD)

Question 8

Give the non-immune mediated delayed transfusion reaction causes

Answer 8

Viral infections

Malaria

Prion

Question 9

What is an acute haemolytic transfusion reaction?

Answer 9

ABO incompatibility

Results in anti-A/B antibodies activating the complement pathway and triggering the release of inflammatory cytokines

Question 10

What are the early clinical features of an acute haemolytic transfusion reaction?

Answer 10

Fever

Hypotension

Anxiety

Red-coloured urine

Question 11

What are the late clinical features of an acute haemolytic transfusion reaction?

Answer 11

Hypotension

Widespread haemorrhage secondary to disseminated intravascular coagulation (DIC)

Question 12

What is transfusion-related acute lung injury (TRALI)?

Answer 12

Pathophysiology not fully understood

Antibodies in the donor blood to human neutrophil antigens and HLA in recipient’s blood have been implicated

Question 13

What is the typical presentation of TRALI?

Answer 13

Sudden dyspnoea

Severe hypoxaemia

Hypotension

Fever within 6 hours after transfusion

Question 14

How long does it take a TRALI to resolve with supportive care?

Answer 14

48 - 96 hours

Question 15

What is anaphylaxis in a transfusion reaction?

Answer 15

Recipient has allergy to protein components present in the donor transfusion

Develops over minutes to hours

Can quickly become life-threatening

Question 16

What are the typical clinical features of anaphylaxis in a transfusion reaction?

Answer 16

Itchy rash

Angioedema

SOB

Vomiting

Lightheadedness

Hypotension

Question 17

What is a delayed haemolytic transfusion reaction (DHTR)?

Answer 17

Caused by antibodies to antigens such as Rhesus or Kidd

Question 18

How many days after the transfusion can DHTR occur?

Answer 18

3 - 14 days

Question 19

What are the typical clinical features of DHTR?

Answer 19

Sudden drop in Hb

Fever

Jaundice

Haemoglobinuria

Question 20

What is febrile non-haemolytic transfusion reaction (FNHTR)?

Answer 20

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

Question 21

What are the typical clinical features of FNHTR?

Answer 21

Fever during blood transfusion

No associated haemolysis

Question 22

Which group of people are more likely to get FNHTR?

Answer 22

Patients who have received multiple transfusions

Multigravidous women

Question 23

What is post-transfusion purpura (PTP)?

Answer 23

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

Question 24

How many days after a transfusion does PTP present?

Answer 24

5 - 12 days

Question 25

What is graft versus host disease (GvHD)?

Answer 25

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

Question 26

Why could GvHD occur after a blood transfusion?

Answer 26

If the blood products used have not be irradiated or treated with an approved pathogen reduction system

Question 27

Which of the blood products is more likely to have bacterial contamination and why?

Answer 27

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.

Question 28

Sources

Answer 28

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