Transfusion Reactions Flashcards
How to do transfusion reaction workup
Perform ABO/Rh type and polyAHG adult DAT on both pre and post-transfusion samples
and get pee specimen
Why do pre-transfusion DAT?
- To make sure post-transfusion DAT positive is due to transfusion
- The patient could be attacking the donor RBCs after transfusion
Steps of treating transfusion reaction
- first identified by infusionist
- worked up by blood banker
- classified by pathologist
- treated by doctor
transfusion reaction classifications
- hemolytic vs non-hemolytic
- acute vs delayed (>24 hr after transfusion)
- product vs patient
signs and symptoms of transfusion reaction
- hemolysis
- raise in temp
- BP change
- shortness of breath
- pain
- limited survival of transfused product
hemolysis signs
- hemoglobinuria
- hemoglobinemia
- hgb level doesn’t rise
- DAT pos
- agglutination on slide
T/F
Plt ABO mismatch cannot cause HTR
False
It can bc some leftover plasma in the product may contain adverse antibodies
symptoms associated with raise in temp
fever
chills
nausea/vomiting
hypotension can lead to ____
shock
hypertension can lead to ____
jugular vein distension
shortness of breath associated with ___
wheezing
anaphylaxis
hypoxemia
angioedema
acute HTR clinical presentation
- rapid onset
- fever
- pain
- hypotension
- hemoglobinemia/hemoglobinuria
acute HTR major complications
- DIC
- renal failure
- shock
cause of acute HTR
complement activation
acute HTR essential lab tests
- clerical/visual checks
- ABO retype
- tests for hemolysis: DAT, bilirubin, haptoglobin, urinalysis
managing acute HTR
- treat DIC and shock
- avoid clerical/technical error
delayed HTR clinical presentation
- time-delay onset
- fever
- unexplained H/H drop
- mild jaundice
major complications of delayed HTR
none
cause of delayed HTR
anamnestic
essential lab tests for delayed HTR
- DAT
- H/H
- tests for hemolysis: bilirubin, haptoglobin, urinalysis
managing delayed HTR
provide antigen-negative results
severity factors for HTR
- antigenicity
- titer
- ability to fix complement
which antibodies cause delayed HTR, DAT pos, and are extravascular
- Kidd
- Duffy
- Kell
- MNS
which antibodies cause acute HTR, DAT pos or neg, and are intravascular?
- ABO
- Rh
- Kell
febrile non-hemolytic transfusion reaction prevention (FNHTR)
leuko-reduced products
FNHTR symptoms
- fever/chills
- nausea
- tachycardia
- hypertension
FNHTR causes
- WBC-derived cytokines in stored product or HLA antibodies in donor component plts
FNHTR lab findings and treatment
- negative DAT
- no visible hemolysis
- treat with acetaminophen (Tylenol)
allergic reaction prevention
use of a different donor’s blood products
allergic reaction symptoms
- urticaria
- itching
- trouble breathing
- hives
- flushing
- hypotension
- anaphylaxis
allergic reaction causes
allergens and proteins in donor product (IgA antigens in plasma)
allergic reaction lab findings and treatment
- negative DAT
- no visible hemolysis
- treat with antihistamine (benadryl)
urticarial vs maculopapular rash
- urticarial: take benadryl and you’ll be fine
- maculopapular: BAD, means graft v host disease
prevention of graft v host disease
irradiation of cellular products to inactivate donor lymphocytes
symptoms of graft v host disease
- maculopapular rash
- fever
- diarrhea
- multi-organ failure
- 90% mortality rate
causes of graft v host disease
recipient does not recognize donor lymphocytes as foreign, but the donor lymphocytes attack the recipient’s RBCs
graft v host disease lab findings
- pancytopenia
- biopsy shows donor lymph infiltrates
- may have bystander infections
graft v host disease treatment
- stem cell transplant
- immunosuppressive treatment
- treat symptoms
transfusion associated lung injury (TRALI) prevention
increase donor deferral for females who have been pregnant and males who have received transfusions
TRALI symptoms
- severe respiratory distress
- severe hypoxia/edema
- fever
- hypotension
TRALI causes
- donor WBC anti-HLA antibodies reactive against recipient WBCS
- recipient primed WBCs activated by biologically active substances in transfused blood products
TRALI lab findings
- recipient positive for HLA/HNA antigens
- donor product positive for HLA/HNA Ab
- chest x-ray has perfusions
TRALI treatment
- stop transfusion
- supportive therapy w oxygen supplementation/mechanical ventilation
TACO prevention
- check lab values before transfusion
- use small volume products for transfusion (split products)
- transfuse slowly
TACO symptoms
- dyspnea
- coughing
- hypertension
- tachycardia
TACO causes
- volume infusion that can’t be processed by pt
- high rates/volumes of infusion
- underlying pathology e.g., CHF
TACO lab findings
- elevated BNP
- no serological hemolysis
TACO treatment
- oxygen supplementation
- diuresis
TRALI risk-factor
pt who received plasma from multiparous (pregnant multiple times) female
TACO risk factor
low circulation or heart output pt
graft v host disease risk factor
immunocompromised pt
prevention of sepsis
- focus on plt expiration dates, proper storage conditions, and bacterial testing of products
- be aware plts pose highest sepsis risk even if irradiated bc stored at RT
sepsis symptoms
- body temp more than 2 degrees above normal
- rigors (shaking chills) + hypotension
sepsis causes
- bacterially contaminated product transfused
- plts: gpcs, gnb (enterics)
- rbcs: gpcs, gnb (enterics)
- plasma: water bath contaminants
sepsis lab findings
blood culture on patient matches product (find same organism in donor bag and pt)
sepsis treatment
ID contaminant and antibiotics
iron overload (hemosiderosis) prevention
transfusion of less than 20 cells in a year or transfusion of washed cells
hemosiderosis symptoms
- yellow-tinge to skin
- multi-organ failure
hemosiderosis causes
accumulation of iron in tissues
too many transfusions
hemosiderosis lab findings
extremely elevated ferritin
hemosiderosis treatment
- therapeutic phlebotomy
- chelation therapy
- exchange transfusion
citrate toxicity prevention
- ingestion of calcium before infusion
- washed products
citrate toxicity symptoms
- paresthesias (tingling or prickling sensation)
- hypotension
- cardiac arrhythmia
- tetany (involuntary muscle contractions)
- coagulopathy
citrate toxicity causes
inability of liver to metabolize amount of anticoagulant infused
patients at risk for citrate toxicity
- liver disfunction/renal disease
- neonates
- hypothermic pt
- plt and FFP recipients
citrate toxicity lab findings
- hypocalcemia
- hypomagnesemia
- prolonged PT
citrate toxicity treatment
calcium
post transfusion purpura prevention
plt crossmatch or HLA matched plt transfusion
post transfusion purpura symptoms
- profound thrombocytopenia
- bleeding
- petechiae
post transfusion purpura causes
patient has plt antibody, usually anti-hpa1
post transfusion purpura lab findings and treatment
- HLA lab workup to determine antibody ID
- treat with IVIG or transfusion of diff product, pooled products might help
recognition of tranfusion reaction by nurse
- fever
- chills
- respiratory distress (coughing, wheezing, dyspnea)
- hyper or hypotension
- pain: abdominal or at infusion site
- skin color/texture changes
- jaundice
- hemoglobinuria/emia
- nausea/vomiting
- unexpected bleeding
- oliguria/anuria
clinical eval and management of transfusion reaction
- stop transfusion, continue w IV saline
- document clerical recheck btwn patient and component
- contact treating physician
- monitor pt vitals
- contact transfusion service
What to do if DAT is pos for IgG?
Elution
Goal of transfusion reaction workup
rule out hemolytic transfusion reaction
steps of transfusion workup testing (preanalytical, analytical, postanalytical)
preanalytical: clerical check and visual hemolysis check
analytical: DAT and ABO re-type
postanalytical: report findings to supervisor or transfusion service med director
further workup if hemolysis present
- elution
- repeat screens on pre and post
- chem tests (LDH, bilirubin, hemoglobin, haptoglobin)
further workup if sepsis sus
blood culture patient, donor unit, and saline attached to unit
further workup if lung injury sus
- contact blood manufacturer for follow-up testing on donor (HLA)
- chest x ray
when to report to FDA?
- when donor product is at fault for causing transfusion reaction, even if it’s just wrong donor selection
- sepsis
- TRALI
- hemolytic
when is it not necessary to report TRN to FDA?
- delayed HTR
- allergic reactions
- febrile non hemolytic
- circulatory overload
