transfusion reactions Flashcards
Canadian vigilance program is focused on
safety of products
What are early signs of transfusion reactions
Fever
chills and rigor
respiratory distress - wheezing, coughing , dyspnea and cyanosis
What would be expected in an acute transfusion reaction if immune or non immune
<24hrs
Immune-
Hemolytic
Allergic
Anaphylactic
TRALI
Non immune mediated
Sepsis
TACO
Physical Hemolysis
Citrate toxicity
What would be expected in a delayed transfusion reaction if immune or non immune
> 24
Immune
Hemolytic
HLA alloimmunization
TA-ghvd
Post transfusion purpura
Non Immune mediated
Hemosiderosis
What do immune vs non immune reactions consist of
Immune mediated - rx with AG+AB complex, cytokine release, complement activation
Non- immune - reactions resulting from component transfused, pts condition or infusion method
What is a hemolytic transfusion reaction
-destruction of transfused red cells resulting in intra or extravascular hemolysis or a combo
- classified as acute due to ABO incompatibility or delayed due to alloimmunization can be immune mediated or non immune mediated
positive DAT
What are Immune-Mediated Acute Hemolytic
Transfusion Reactions - signs
AHTR
red cell destruction within 24 hours of transfusion of red cells
- fever, chills, oozing from site , nosebleed, DIC, renal failure
First thing that happens is AB - AG = complex that causes hemolysis
-how bad the transfusion reaction is depends on what the AG or AB are like
-the most severe reactions occur when AB interact with red cells causing complement activation
Which AB activated complement
AB of IgM at 37 = intravascular hemolysis
-release of hemoglobin
AB of IgG are less likely to activate complement but can react with Fc receptors on mononulcear cells to impact phagocytosis and activation of coag system
What is Hemostatic Dysfunction
examples
-initiation of coag and fibrinolytic systems
DIC - when clotting factors are consumed Fib, FV and FVIII. Causes bleeding into organs = multi organ failure
Renal failure - severe AHTR multifactorial event
hypotension, vasoconstriction,
What errors can cause AHTR
- collecting blood from wrong patient
-incorrect labelling - Wrong unit/wrong ID from blood bank
-transfusion to wrong patient
-aliquotting pt sample into incorrect labelled tube
What is Immune-Mediated Delayed Hemolytic
Transfusion Reactions
- recipient has immunization after red cell exposure from prior transfusions or pregnancy - pretransfusion testing should testing but wont if AB is below detectable levels or if it was missed due to sensitivity of test
-low frequency AG was not demostrated
What is the first sign of DHTR
- inadequate increase of post transfusion hgb or decrease, appearance of spherocytes
-red ALLO ab appearing 24 hrs - 28 days after transfusion - DEFINITIVE
-Rh (particularly anti-C and anti-E), Kidd, Duffy, Kell, and MNS blood group systems
-sign is FEVER and fall in hgb, jaundice on day 5 and hemoglobinuria
What can cause Non-Immune Mediated Mechanisms
of Red Cell Destruction
Exposure of red cells to extreme temperatures (>50°C or <0°C)
Mechanical destruction of red cells
Incompatible solutions
Transfusion of bacterially contaminated blood products
Intrinsic red cell defect attributable to a clinical condition
Examples of Exposure of red cells to extreme temperatures (>50°C or <0°C) that cause Non-Immune Mediated Mechanisms of Red Cell Destruction
- if blood warming devices malfunction or are unregulated
-RBC units are frozen without additive cyroprotectant or proper deglycerolizing of unit when thawed
Examples of Mechanical destruction of red cells that cause Non-Immune Mediated Mechanisms of Red Cell Destruction
small bore needles, valves, excessive pressur and blood salvage equipment
Examples of Incompatible solutions that cause Non-Immune Mediated Mechanisms of Red Cell Destruction
Blood mixed with half strength saline, 5% dextrose in 0.18 saline, ringers lactate, medications that cause osmotic rupturing of cells
What disease states are responsible for hemolysis
SCD
burns
G6PD
PCH
What is a Febrile Nonhemolytic Transfusion
Reaction and its most common cause
- adverse effect of transfusion
-occurs in a >1 degree rise in temp so 38 or higher either before or upto 4 hours AFTER transfusion
-chills, fever, rigor, vomiting - transfused cytokines or the cytokines in the pt that respond to transfused leukocytes
-HLA AB can be the cause as well
DAT NEG
do LR to prevent
What are Allergic Transfusion Reactions
Mild
associated with a plasma component with symptoms from the start of transfusion
Urticarial reactions from exposure to foreign allergen in the blood product
-Class 1 hypersensitivty response IgE AB in recipient react with allergen (plasma protein) that activates mast cells causing degranulation , histamine release
symptoms Urticaria (hives) and pruritus (itching)
DAT NEG
What are Allergic Transfusion Reactions
severe
Anaphylactic
Non IgE triggers the release of mast cells causing urticaria and angioedema
-severe hypotension, fainting, dyspnea, wheezing
-found in IgA deficient patients that made anti IgA but didnt get washed red cell and plasma components
treat with methylprednisolone, prednisone,
or epinephrine.
DAT NEG
What is Transfusion-Related Acute Lung
Injury
- diagnosis relies on symptoms but overlaps with circulatory overload, anaphylactic reactions
-respiratory distress and pulmonary edema can occur during transfusion or in 6 hours
-fever, chills. no nproductive cough , tachycardia
if order to specifically diagnose acute hypoxia associated with acute lung injury after transfusion you need to do respiratory measurements with a chest xray to show bilateral infiltrates
how does TRALI occur
- from recipient underlying medical condition or from the transfusion itself
- plasma from women donor that were exposed to fetal HLA ag (pregnancy) can cause HLA and neutrophil AB
-seen as hypoxemia
-presence of class 2 AB = increased TRALI risk
-ANTI HLA donor
ANTI HNA donor
DONOR WBC AB is the cause
DAT neg
What is Transfusion-Related Graft Verses
Host Disease
immune response mediated by immunocompetent donor lymphs
-3-30 days after transfusion with rash, pancytopenia , increased liver function
-transfuse with donor lymphs to a recipient that is immunologically incompetent or HLA similar
-must irradiate blood before transfusion with Gamma irradiation
The major sources of the bacterial contamination in blood
-donor has asymp bacteremia at time of donation
-bacterial infection that survives the storage condition of RBC and platelets
-pinhole in blood collection set, error in testing, SOP not followed
