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MLSCI 370 > Transfusion Reactions > Flashcards

Transfusion Reactions Flashcards

1
Q

Acute Hemolytic Rxn Causes

A
  • ABO incompatibility = complement binding to C9 = IVH

Rare:
- pre-formed Ab in recipient
- no Ab screen/ unmatched blood (emergency)
- low frequency antigen (Cw, V, Kpa - Ab screen will be falsely neg)
- Kidd, Kell, Rh Ab

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2
Q

Time of Immediate Hemolytic Rxn

A

First 15 minutes of transfusion

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3
Q

Blood products associated to Immediate Hemolytic Rxn

A
  • RBC
  • plasma
  • platelets (less severe)
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4
Q

Immediate Hemolytic Rxn Symptoms

A
  • fever/ chills
  • chest pain/ shortness of breath
  • angioedema; “vessels swelling”
  • DIC
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5
Q

Causes of Febrile Non-Hemolytic Rxns

A
  • cytokines in platelet products
  • HLA (white blood cell) antibodies in patient reacts with donor WBCs
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6
Q

Time of Febrile Non-hemolytic Reactions

A

2-4 hours from start of transfusion

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7
Q

Treatment of Febrile Non-hemolytic Rxns

A
  • acetominophen
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8
Q

Prevention of Febrile Non-hemolytic Rxns

A
  • pre-storage leukoreduction
  • washing products to remove contaminants
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9
Q

Cause and Effect of Mild Allergic Reactions

A
  • Patient’s IgE Ab reacts with allergen in donor PLASMA (food, protein, preservative)
  • Ab binds mast cells = release granular contents (histamine) = urticarial and pruritis
  • BP and RESPIRATORY UNAFFECTED, with mild tachycardia

urticarial = hives
pruritis = itching
tachycardia = increased HR

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10
Q

Time of Mild Allergic Rxns

A

1-45 min from start of transfusion

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11
Q

Treatment/ Prevention of Mild Allergic Rxns

A
  • anti-histamines
  • restart transfusion more slowly
  • pre-treat with anti-histamines
  • washing to remove contaminants
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12
Q

Another name for Mild Allergic Rxns

A

Urticarial Rxns

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13
Q

Cause of Anaphylactic Allergic Rxns

A
  • donor IgA is the “antigen” !
  • recipient is IgA deficient and makes an anti-IgA from previous transfusions
  • can be an allergen ie. peanuts (rare)
  • more severe patient IgE = mast cell degranulation
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14
Q

Time of Anaphylactic Allergic Rxns

A
  • WITHIN MINUTES (1-15 min) of start of transfusion
  • can start as mild and progresses
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15
Q

Symptoms of Anaphylactic Allergic Rxns

A
  • urticaria, pruritis, dyspnea, low BP, hypoxemia, smooth muscle contractions (GI and respiratory), vasodilation

urticaria = hives
pruritis = itching
dyspnea = shortness of breath

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16
Q

Treatment for Anaphylactic Allergic Rxns

A
  • epinephrine
  • antihistamine
  • corticosteroids (anti-inflammatory)
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17
Q

Prevention of Anaphylactic Allergic Rxns

A
  • request IgA deficient products
  • wash products to remove IgA
  • prepare drugs
  • transfuse with MD supervision
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18
Q

Cause of Bacteriogenic Rxns

A

bacteria in PLATELETS and BLOOD products:
- normal skin flora
- transient bacteremia in donor (dental bleeding)
- contamination during processing
- improper temp storage

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19
Q

List bacteria that can cause bacteriogenic rxns

A
  • E. coli
  • Pseudomonas
  • Yersinia enterocolitica
20
Q

Time of Bacteriogenic Rxns

A

Variable:
- minutes if toxins are present
- several days if low microbial count

21
Q

Symptoms of Bacteriogenic Rxns

A
  • fever, chills
  • low BP
  • tachycardia
  • DIC
22
Q

Treatment of Bacteriogenic Rxns

A
  • Broad spectrum antibiotics
  • Blood culture the donor product (aerobic/ anaerobic) to ID
23
Q

Cause of Delayed Hemolytic Reaction

A
  • Ab formation to non-ABO Ag (Rh, Kell, Duffy, Kidd, Ss) on BLOOD products
  • EVH; Ab binds donor cells and removed by spleen
24
Q

Timing of Delayed Hemolytic Rxns

A
  • 2-14 days post-transfusion
  • due to secondary exposure
25
Q

Symptoms of Delayed Hemolytic Rxns

A
  • fever, chills
  • malaise
  • jaundice
  • no symptoms at all

malaise = discomfort

26
Q

Treatment of Delayed Hemolytic Rxns

A

NONE
- monitor Hb, bilirubin, LD, haptoglobin

27
Q

A post- transfusion investigation takes into account… (3)

A
  1. type of products transfused
  2. signs and symptoms
  3. serological results from a post-transfusion sample
28
Q

when are patient vital signs taken? (HR, BP, temp)

A
  • before transfusion
  • 15 mins after start
  • end of transfusion
29
Q

In the first 15 mins, transfusion is slow and patient is monitored for any signs/ symptoms of reaction. What must be done if a reaction occurs ?

A
  • STOP transfusion, but maintain IV line, and run saline
  • notify attending physician immediately
  • document vital signs and symptoms
  • bedside clerical check with the product tag/vs patient (2 identifiers)
  • notify blood bank
  • return unused product, along with post-transfusion specimen (EDTA) to blood bank

NOTE: even minor reactions must be reported ie. resolved within 20 mins

30
Q

Positive post-transfusion __ is significant ! Why?

A

Positive post-transfusion DAT is significant !

  • it can indicate DELAYED transfusion rxn; depending on time of investigation, DAT may be only indicator
31
Q

List other rare causes of positive post-transfusion DAT (3)

A
  • passive antibody
  • IVIg that binds non-specifically to RBC
  • donor is already DAT pos
32
Q

T or F: Rh binds complement

A

FALSE; Rh DOES NOT bind complement

NOTE: (Rh)ude MeaN (Du)des don’t give out complements

33
Q

Why does complement only bind in vivo?

A

because in vitro, EDTA chelates Ca 2+ and Mg 2+

34
Q

indicators of IVH

A
  • visible hemolysis (plasma Hb)
  • hemoglobinuria (due to increased Hb)
  • decreased haptoglobin (bc it is complexed)
  • increased LDH
35
Q

indicators of EVH

A
  • increased bilirubin
  • increased LDH
  • decreased haptoglobin (bc it is complexed)/ OR unaffected
  • decreased Hb
36
Q

List steps to a transfusion rxn investigation (8)

A
  1. Clerical check
  2. Review symptoms (documented on tag)
  3. NOTE:
    - product transfused
    - time of transfusion to symptoms (week ago = not febrile; minutes = severe allergic)
    - volume transfused
  4. Check for visible hemolysis on post-transfusion sample
  5. Serological tests (ABO Rh, Ab screen, DAT, XM)
  6. Non-serological tests (bilirubin, Hb, LDH, haptoglobin)
37
Q

Which products will NOT cause a delayed hemolytic rxn ?

A

plasma and platelets

38
Q

In the event of a transfusion rxn, what tests do we run on a pre-transfusion sample ? (4)

A
  1. clerical check
  2. ABO Rh
  3. AbScr
  4. Serological XM
39
Q

In the event of a transfusion rxn, what tests do we run on a post-transfusion sample ? (6)

A
  1. clerical check
  2. check for visible hemolysis
  3. ABO Rh
  4. Abscr
  5. DAT
  6. serological XM
40
Q

In the event of a transfusion rxn, what tests do we run on the donor segment ? (3)

A
  1. clerical check
  2. ABO Rh
  3. Ag type for any Ab detected in the pre- or post-Ab screen
41
Q

Serious transfusion rxns will involve a consultation with __.

A

Serious transfusion rxns will involve a consultation with the pathologist.

42
Q

What happens to existing allocated units that showed transfusion rxn ?

A

They are quarantined until permission is given to release

43
Q

Describe Delayed Hemolytic Rxn Workup

A
  1. Ab ID if AbScr = pos
  2. Elution on DAT pos cells
  3. Ag type donor segment; DO NOT TYPE DONOR (transfused within 3 months)
  4. Update records
  5. Serological XM with suspect donors
  6. Serological XM Ag neg donors for next transfusion if collection still valid (96 hrs)
44
Q

What would cause a positive DAT on a post-transfusion sample ?

A
  • ABO incompatible cells = immediate hemolytic run
  • Mild allergic + severe anaphylactic rxn
  • Autoimmune hemolytic (warm/ cold) anemia
  • Drug-induced hemolytic anemia
  • HDFN
45
Q

If a patient has a delayed hemolytic rxn, why might the DAT = negative ?

A

All donor cells have been destroyed due to EVH before post-transfusion sample is collected

MLSCI 370 (7 decks)

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