transfusion reactions Flashcards
- determines ABO and Rh
- looks for alloantibodies- mix pt serum with type O RBCs who’s extended phenotype is known
type and screen
- pt serum and donor RBCs are mixed
- blood selected must be ABO compatible– lack antigens for which the patient has allobodies
- confirms absence of major incompatibility
cross match
- the most severe hemolytic transfusion reaction
- from ABO isoagglutinin
- rapid onset
- intravascular
- dose dependent
- s/sx due to complement system activation
acute hemolytic reaction
acute hemolytic reaction symptoms
fever/chills/rigors
discomfort at the infusion site
dyspnea
tachycardia
backache and or headache
hemoglobinemia/hemoglobinuria
DIC
hypotension/shock
renal failure
death
what to do for acute hemolytic reactions
- monitor vitals carefully before and during
- stop transfusion immediately
- IV fluids and mannitol to prevent acute kidney injury
- monitor for DIC with coat studies
acute hemolytic reactions are usually the result of…
mislabeling or giving to wrong patient
- usually caused by minor RBC antigen discrepancies
- extravascular
- may have no symptoms
- usually occurs in pts previously sensitized, but have low antibody levels and a negative alloantibody screen
- 3-10 days after transfusion
- can cause a drop in hemoglobin and increase in total and indirect bilirubin
- newly positive serum alloantibody test
- no specific treatment required
delayed hemolytic reaction
what to do for hemolytic reactions
- make sure the recipient was the right patient
- return the blood to the bank with fresh sample of recipient blood
- Hgb will not rise expected due to hemolysis
- check for AKI or DIC
- most frequent transfusion reaction**
- mediated by antibodies against donor leukocyte antigens
- pts with prior exposure
- chills and rigors within 12 hours of transfusion
- at least a 1 degree celsius rise in temperature
- Hgb increase as expected– no hemolysis
febrile non-hemolytic transfusion reaction/leukoagglutinin reactions
what to do for febrile non hemolytic transfusion reactions
- leukocyte reduced blood products make these less frequent and less severe
- especially before storage
- pretreatment with acetaminophen
- can treat with acetaminophen and Benadryl
- IV corticosteroids may also be used
- Hives or bronchospasm– related to allogenic plasma proteins found in transfused components
- risk is low: premedication is not routine
- mild reactions: transfusion can be temporarily stopped while diphenhydramine is admitted
- cellular components can be washed to remove plasma in patients with history of severe reaction or autologous blood components
allergic reactions
- starts after only a few ml have been transfused
- difficulty breathing
- coughing
- n/v
- hypotension
- bronchospasm
- LOC
- respiratory arrest
- shock
anaphylactic reaction
what to do for anaphylactic reaction
- stop transfusion immediately
- administer epinephrine
- maybe glucosteroids if severe
- IgA deficient patients are at risk
- lymphocytes from the donor attack and cannot be eliminated by an immunodeficient host
- fever, rash, diarrhea, hepatitis, lymphadenopathy
- marrow aplasia, severe pancytopenia
- clinical manifestations appear at 8-10 days and death occurs 3-4 weeks later
graft vs host disease
how is graft vs host disease prevented
irradiation of cellular components before transfusion to at risk patients prevents lymphocyte proliferation in blood products
- non cardiogenic pulmonary edema within 6 hours after a blood product transfusion without other explanation
- surgical and critically ill patients most susceptible, usually with pre existing lung disease
- sudden acute respiratory distress following transfusion
- priming of neutrophils by inflammation of lung endothelial microvasculature
- activation when antibodies in donor plasma bind to recipients leukocyte antigens
- or sometimes no anti leukocyte Ab are identified so possibly triggered by something in blood product
transfusion related acute lung injury (TRALI)
what to do for transfusion related acute lung injury (TRALI)
supportive treatment
how to prevent transfusion related acute lung injury (TRALI)
- male only plasma donors
- women have more anti- leukocyte Ab in serum, esp after multiparity
- cardiogenic pulmonary edema within 6 hours of transfusion
- excessive volume or rate of transfusion
- respiratory distress
- CV systems changes
- elevated brain natriuretic peptide (BNP) or N-terminal-proBNP (NT-BNP) relevant marker
- positive fluid balance
transfusion associated circulatory overload (TACO)
TACO management
- use the least amount of product needed*
- stop transfusion
- diuretics and inotropes
- supportive care
production of maternal IgG antibodies directed against an antigen on fetal cells
hemolytic disease of the newborn
how does hemolytic disease of the newborn happen
- if Rh (D) negative woman carries Rh (D) positive fetus
- fetal RBCs can enter maternal circulation from small feto-maternal bleeding episodes (delivery, abortion, ectopic pregnancy, placental abruption, trauma)
- once produced the antibodies remain in a woman’s circulation and pose a threat for Rh positive fetus
prevent hemolytic disease of the newborn (first prenatal visit)
screen all women for:
ABO and Rh status
indirect Coomb’s test (determines antibodies to Rh factor in mother’s blood)
prevent hemolytic disease of the newborn (28 weeks)
- indirect Coomb’s test
negative: give Rhogam (anti-D-immunoglobulin) (destroys fetal Rh positive cells so mother will not produce anti-Rh (D) in next pregnancy
positive: immune globulin no longer helpful
