Transfusion Reactions Flashcards
Antigens of the blood that we produce antibodies against the ones we lack.
Blood Types
(A, B, AB, O)
What percentage of people are Rh+
85%
What percentage of people are Rh-
15%
In an emergency, can Rh+ be given to a patient that is Rh-
Only if they lack Rh antibodies
(Will likely become alloimmunized)
Most severe hemolytic transfusion reaction usually from ABO isoagglutinin
Acute Hemolytic Reaction
Is an Acute Hemolytic Reaction intravascular or extravascular?
Intravascular
What are some of the signs and symptoms of Acute Hemolytic Reaction?
Fever and Chills
Dyspnea
Tachycardia
Hemoglobinemia
Hemoglobinuria
Disseminated Intravascular Coagulation
Shock
Renal Failure
Death
How soon after transfusion does an Acute Hemolytic Reaction present?
Within 24 hours
How do you treat a patient with Acute Hemolytic Reaction?
IV Fluids + Mannitol to prevent Kidney Injury
Stop the Transfusion Immediately
Monitor for DIC with coagulation studies
What is the usual cause of Acute Hemolytic Reaction?
Mislabeling
Administered to Wrong Patient
Where do most severe Acute Hemolytic Reactions occur?
Operating Room
Reaction that is usually caused by minor Red Blood Cell antigen discrepancies.
Delayed Hemolytic Reaction
Is a Delayed Hemolytic Reaction intravascular or extravascular.
Extravascular
How soon after transfusion does a Delayed Hemolytic Reaction occur?
3 - 10 days
What are the symptoms of a Delayed Hemolytic Reaction?
May have no signs or symptoms
Usually less severe, but not always
What types of patients are susceptible to having a Delayed Hemolytic Reaction?
Previously sensitized patients that have low antibody levels and a negative alloantibody screen
How is a Delayed Hemolytic Reaction treated?
No specific treatment
May need additional transfusions
Most frequent transfusion reaction that occurs. Caused by Leukocyte rich products.
Febrile Non-hemolytic Transfusion Reaction
(Leukoagglutinin Reaction)
What patients are more susceptible to Febrile Non-Hemolytic Transfusion Reactions or Leukoagglutinin Reactions?
Patients with prior exposure to donor Leukocytes
(Transfusions or Pregnancy)
How much must the patients temperature increase by to be considered a Febrile Non-hemolytic Transfusion Reaction or Leukoagglutinin Reaction?
1° Celsius
How do you treat Febrile Non-hemolytic Transfusion Reactions or Leukoagglutinin Reactions?
Acetaminophen + Benadryl
(IV Corticosteroids may also be used)
How soon after a transfusion will anaphylaxis occur in a patient?
After a few mL of Blood
How do you treat an anaphylactic reaction due to a blood transfusion?
Stop the Transfusion Immediately
Administer Epinephrine
Glucocorticoids (if severe)
What patients are at risk for anaphylaxis due to a blood transfusion?
IgA deficient patients
(should receive IgA deficient plasma)
A disease where lymphocytes from the donor attack and cannot be eliminated by an immunodeficient host.
Graft-vs-Host Disease
What are the signs and symptoms of Graft-vs-Host disease?
Fever
Rash
Diarrhea
Hepatitis
Marrow Aplasia
Severe Pancytopenia
How soon after transfusion does Graft-vs-Host disease appear?
8 - 10 days
What is the prognosis for Graft-vs-Host disease?
Usually fatal
(death occurs in 3 - 4 weeks)
How can Graft-vs-Host disease be prevented?
Irradiation of Cellular Components
Non-cardiogenic pulmonary edema that occurs within 6 hours of a blood product transfusion without other explanation.
Transfusion-Related Acute Lung Injury
(TRALI)
What types of patients are most susceptible to Transfusion-Related Acute Lung Injury (TRALI)
Surgical and Critically ill with pre-existing lung disease
What is the pathophysiology of Transfusion-Related Acute Lung Injury
Priming of neutrophils via inflammation of lung endothelial microvasculature
How do you treat Transfusion-Related Acute Lung Injury?
Supportive Treatment
(usually resolves without complications)
How can we prevent Transfusion-Related Acute Lung Injury (TRALI)
Male-only Plasma Donors
(women have more anti-leukocytes antibodies)
Cardiogenic pulmonary edema that occurs within 6 hours of a blood transfusion.
Transfusion-Associated Circulatory Overload
(TACO)
What causes Transfusion-Associated Circulatory Overload (TACO)
Excessive volume or rate of transfusion
What are the signs and symptoms of Transfusion-Associated Circulatory Overload?
Respiratory Distress
Lower Extremity Swelling
Heart Failure
What might be elevated in a patient with Transfusion-Associated Circulatory Overload?
Brain Natriuretic Peptide (BNP)
N-terminal-proBNP (NT-BNP)
What are two patient-related risk factors for Transfusion-Associated Circulatory Overload (TACO)
Younger than 3
Older than 60
Pre-existing Cardiac Dysfunction
How do you treat Transfusion-Associated Circulatory Overload?
Diuretics + Inotropes
Stop the Transfusion
Supportive Care
Are viruses or bacteria more commonly transmitted during a blood transfusion?
Viruses
Are platelets or red blood cells more likely to be contaminated and transmit disease?
Platelets
(stored at room temperature)
An Rh- negative woman carries an Rh + fetus. The mother’s second pregnancy now poses a threat to a subsequent Rh+ fetus.
Hemolytic Disease of the Newborn
A test used to determine whether there are antibodies to the Rh factor in the mother’s blood
Indirect Coomb’s Test
When are women screened for blood type and Rh status?
First Prenatal Visit
28 Weeks
When is the Indirect Coomb’s Test performed on a pregnant woman?
First Prenatal Visit
28 Weeks
40 Weeks
If a mother’s Indirect Coomb’s Test is negative for antibodies against Rh factor, what should you administer?
Rhogam
When is Rhogam administered to a Rh- mother that is not producing antibodies against Rh factor?
28 Weeks
40 Weeks
(or if more than 12 weeks since last dose)
What does Rhogam do?
Destroy fetal Rh positive cells so the mother will not produce anti-Rh antibodies in the next pregnancy.
If the mother is positive for antibodies against Rh factor, is Rhogam helpful?
No
If a Rh- mother gives birth to an Rh+ baby, what should be administered to within 72 hours after delivery?
Rhogam
How do you manage an Rh- mother with known maternal alloimmunization (antibody against Rh factor)
Determine fetal Rh
Monitor for fetal anemia if the baby is Rh+
How do you treat a baby with Severe Fetal Anemia that is near term?
Delivery
How do you treat a baby with Severe Fetal Anemia that is remote from term?
Intrauterine Fetal Transfusions
Result of Hemolytic Disease of the Newborn that occurs prior to birth and causes heart failure, and large amount of fluid buildup. Risk for being stillborn
Hydrops Fetalis
Result of Hemolytic Disease of the Newborn that occurs after birth and causes the most severe form of hyperbilirubinemia, a buildup of bilirubin in the baby’s brain. Can cause seizures, brain damage, deafness, and death.
Kernicterus
