Transfusion reactions Flashcards
What reaction has a rapid onset fever/chills/rigor, discomfort at site of infusion, dyspnea, tachycardia, backache/headache, hemoglobinemia/hemoglobinuria, DIC, hypotension, renal failure, death?
acute hemolytic transfusion reaction
When is the most severe acute hemolytic reaction?
intraoperative, from ABO isoagglutinin or alloantibodies (mislabelling, giving to wrong patient)
How do you manage acute hemolytic transfusion reaction?
DIC w/ coag studies, vitals, stop transfusion immediately!!
IV fluids + mannitol to prevent acute kidney injury
What reaction is 3-10 days after transfusion and possibly asymptomatic?
delayed hemolytic transfusion reaction
In who is delayed hemolytic transfusion reaction common?
patients previously sensitized but low antibody levels and alloantibody screening
How can you diagnose delayed hemolytic transfusion reaction?
drop in hemoglobin and in crease in total and indirect bilirubin
newly + serum alloantibody test
How do you treat delayed hemolytic transfusion reaction?
none required but additional blood transfusions may be needed, check for AKI or DIC
What type of reaction is chills and rigor w/n 12 hours of transfusion (1 degree C rise in temp) with severe having cough, dyspnea?
febrile non-hemolytic transfusion reaction “leukoagglutinin reaction”
In who is febrile non-hemolytic transfusion reaction common?
patients w/ prior exposure (transfusions or pregnancy)
In what is febrile non-hemolytic transfusion reaction caused by?
leukocyte rich products and mediated by antibodies against donor
How do you diagnose febrile non-hemolytic transfusion reaction ?
Rule out other causes of fever – Hgb increases, no hemolysis
How do you manage febrile non-hemolytic transfusion reaction ?
change to reduced leukocyte blood products (make reactions less severe)
pretreat w/ acetaminophen
acetaminophen and Benadryl (diphenhydramine) and consider IV corticosteroids
What reaction has hives, bronchospasms, mild (allergic) or starting immediately with dyspnea, coughing, n/v, hypotension, bronchospasm, LOC, respiratory arrest, shock (anaphylactic)?
allergic reaction to blood transfusion
Who is at risk for allergic reaction to blood transfusion?
igA-deficient patients
What is allergic reaction to blood transfusion?
reaction to plasma proteins
How ca n you prevent allergic reaction to blood transfusion?
washed to remove plasma for history, and pre-treatment
How do you treat allergic allergic reaction to blood transfusion
stop transfusion temporarily and administer diphenhydramine
How do you treat anaphylactic allergic reaction to blood transfusion?
stop transfusion immediately and administer epinephrine, maybe glucocorticoids
How do you treat IgA deficient allergic reaction to blood transfusion
IgA deficient plasma and washed cellular components
What is usually fatal and symptoms occur 8-12 days post transfusion, then fever, rash, diarrhea, hepatitis, lymphadenopathy, marrow aplasia, severe pancytopenia?
graft vs host disease
How can you treat graft vs host disease?
can’t really treat, but you can prevent – irradiation of cellular components before transfusion in at risk patients — fetuses, lymphoma patients, immunosuppressed, recipients from blood relative, recipients w/ marrow transplantation – all need to be washed
What is sudden acute respiratory distress following transfusion?
TRALI - transfusion-related acute lung injury, mainly in surgical and critically ill patients
What causes acute respiratory distress following transfusion?
non-cardiogenic pulmonary edema w/n 6 hours after blood product transfusion without other explanation (antibodies bind to recipient’s leuokocyte antigens)
How can you prevent TRALI?
male-only plasma donors (women have more anti-leukocyte Ab)
How can you treat TRALI?
supportive treatment, can resolve w/o squeale
What’s a transfusion reaction with respiratory distress AND CV system changes like edema, signs of heart failure?
TACO! transfusion associated circulatory overload
In who is TACO at risk?
<3 or >60, preexisting cardiac dysfunction, acute kidney injuries, chronic pulmonary disease, anemia, shock, faster rate of transfusion, using plasma, + fluid balance, lack of diuretics
What causes TACO?
cardiogenic pulmonary edema w/n 6 hours – excessive volume or rate of transfusion
How can you diagnose TACO?
elevated brain neuritic peptide (BNP) or N-terminal-proBNP (NT-BNP) relevant marker, positive fluid balance
How can you treat TACO?
stop transfusion, use least amount of transfusion needed, diuretics and inotropes (helps heart pump), supportive
What type of transfusion reaction is regarding fever, chills, hypotension?
infectious transmission, from a direct transmission of contagious disease (commonly virus MC or contaminated blood)
How can you treat infectious transmission?
antibiotics (and can start before lab confirmation)
What is characterized by either prior to birth hydrops fetalis (heart failure, fluid buildup, organs struggling) OR after birth, kernicterus (hyperbilirubinemia, buildup of bilirubin in baby’s brain, seizures, brain damage, deafness, death)?
hemolytic disease of newborn
If Rh (D) negative women carries Rh positive and can enter circulation, what happens?
early 3rd trimester or during delivery, abortion, ectopic pregnancy, placental abruption, procedures, trauma
What causes hemolytic disease of newborn?
production of maternal IgG antibodies directed against antigen on fetal cells (subsequent threatening of Rh+ fetus)
At first prenatal visit you screen everyone for…
ABO and Rh status — if Rh positive, you’re done!
If Rh negative, continue –> indirect Coomb’s test, (are there antibodies?)
What do you do at the 28 weeks for Rh negative patients?
Indirect Coomb’s test, if negative to antibodies, give anti- D immunoglobulin (rhogam) to stop mom’s production
If positive for antibodies, it’s too late, lasts 12 weeks!
What do you do at the 40 week visit for Rh negative patients?
consider administering again if not in labor
What should you do postpartum?
passive immunization w/n 72 hours
How should you treat hemolytic disease of newborn if already positive for antibodies?
determine fetal D type and monitor for fetal anemia if fetus is a D-positive (risk of death)
severe = early delivery
remote from term = intrauterine fetal transfusions
