TRANSFUSION REACTIONS

Question 1

Most commonly occurring adverse transfusion reactions:

Answer 1

Allergic Transfusion Reaction

Question 2

Most common causes of fatalities due to adverse transfusion reactions:

Answer 2

TRALI (Transfusion-related acute lung injury)

Question 3

Steps and responsibilities of MedTech in evaluation of suspected transfusion reaction:

Answer 3

1. Perform primary testing on postreaction sample
   - Clerical check
   - Hemolysis check (If hemolysis is present, it indicates HTR)
   - Perform DAT (Also indicates HTR)
   - Verify ABO type
2. Report findings to the transfusion service physician
3. Perform additional testing as per transfusion service physician orders

Question 4

Occurs during/within 24 hours after blood transfusion; associated with IgM alloantibodies that causes IV hemolysis; Signs and symptoms are associated with hemolysis and serologic evidence of RBC incompatibility occurring during or within 24 hours after transfusion

Answer 4

Acute HTR

Question 5

Occurs 24 hours to 28 days after blood transfusion; associated with IgG antibodies (Kidd and Duffy); Fining of positive DAT 24 hours to 28 days after transfusion with either a positive eluate or a newly identified alloantibody in the plasma/serum and evidence of hemolysis.

Answer 5

Delayed HTR

Question 6

Leading cause of mortality due to adverse reactions to transfusion; clinical presentation includes acute respiratory distress, dyspnea, tachypnea, and hypoxemia

Answer 6

Transfusion-related acute lung injury (TRALI)

Question 7

Most frequently implicated antibodies of TRALI:

Answer 7

Anti-HLA (human leukocyte antigen)
Anti-HNA (human neutrophil antigen)

Question 8

Characterized by acute respiratory distress from pulmonary edema caused by increase intravascular volume due to excessive transfused fluid; also caused by too rapid of an infusion rate and the inability of the patient to accommodate the volume of transfused products

Answer 8

Transfusion-Associated Circulatory Overload (TACO)

Question 9

The measurement of _____ may be helpful in the diagnosis of TACO (1.5 times greater than the pretransfusion level supports the diagnosis)

Answer 9

BNP levels

Question 10

Defined as a drop in the systolic BP of >/= 30 mmHg and systolic BP </= 80 mmHg; cases report implicated bedside leukoreduction filters and/or ACE inhibitors:

Answer 10

Hypotensive Transfusion Reaction

Question 11

Defined as fever greater than 100.4F 938C) or a change of at least 1.8F (1.0C) from the pretransfusion level occurring during or within 4 hours after transfusion; Most cases are caused by recipient anti-WBC antibodies triggering release of proinflammatory cytokines

Answer 11

Febrile Nonhemolytic Transfusion reaction (FNHTR)

Question 12

Most common reactions seen with platelet and plasma transfusions;

Answer 12

Allergic Transfusion Reactions (ATRs)

• the terms “allergic”, “anaphylactoid”, and “anaphylactic” are used to generally categorize ATRs
• The most common manifestations of ATRs are mucocutaneous reactions, including urticaria, pruritus, and localized or generalized rash

Question 13

Prevention for ATRs:

Answer 13

Use of washed RBCs

Question 14

Rare but has a very high mortality rate; develops from 2 days to 6 weeks after transfusion characterized by the typical skin rash seen, diarrhea, fever, enlarged liver, elevated liver enzymes, marrow aplasia, and/or pancytopenia; Donor immunologically competent CD8+ cytotoxic T lymphocytes are directed against recipient cell surface histocompatibility antigens and mediate cell destruction (Donor lymphocytes attach the MHC antigens of the recipient cells)

Answer 14

Transfusion-Associated Graft-verus-Hist Disease (TA-GVHD)

Question 15

Rare transfusion reaction in which there is a sudden drop in the platelet count, usually occuring 5 to 10 days after transfusion due to alloimmunization to platelet-specific antibodies from prior transfusion or pregnancy

Answer 15

Post-Transfusion Purpura (PTP)

Question 16

Occurs when a bacteria-contaminated blood component is transfused;

Answer 16

Transfusion-Transmitted Bacterial Infection (TTBI)

Question 17

TTBI is more often associated with ____________ than RBCs

Answer 17

Platelet concentrate

because plt conc. are stored in room temperature.

Question 18

Delayed, nonimmune complication of transfusion, presenting with multiorgan damage secondary to excessive iron accumulation (chronic transfusion)

Answer 18

Iron overload

Question 19

Each unit of red blood cells contains approximately _____ mg of iron

Answer 19

250 mg of iron