Transfusion Reactions Flashcards
Alloantibodies
Cold antibodies, usually not clinically significant
Check cells
Control cells coated in IgG
Bump in Platelet count after Transfusion
5000 ul/unit after transfusion
Hemolytic Transfusion Rxn
Destroys transfused RBCs in-vivo and causes systemic damage
Intravascular Hemolytic Transfusion Rxn
Usually acute, IgM activates complement which lyses the cells and increases serum and urine hemoglobin content
Extravascular Hemolytic Transfusion Rxn
Ab coated RBCs are removed by liver and spleen, lysing the cells and releasing bilirubin, the Ab do not activate complement
Nonhemolytic Transfusion Rxn Types
Febrile or allergic, caused by HLA antibodies
Immediate/Acute Transfusion Rxn (Symptoms, Lab Findings)
Within hours of transfusion, fever, chills, flushing, tachycardia, hemoglobinemia, hemoglobinuria, hypotension → lead to DIC, renal failure, shock, and death. Will show increased bilirubin, low haptoglobin, and (+) DAT
Delayed Transfusion Rxn (Lab Findings, specific Ab, symptoms, Secondary cause)
Days or weeks after transfusion, usually less severe (excluding Kidd) depending on the level of Ab in the blood, show fever and/or jaundice, from alloantibodies to Rh, Duffy, and Kidd. Show (+) DAT, (+) post- Ab screen low HGB and HCT. Can be due to a rebound in titer of an antibody which had decreased below detectable limits, Kidd antibodies are prone to this.
Immune-mediated Transfusion Rxn (Cause, symptoms, patient type, correction)
RBC/HLA antigens reacting with Ab, cause nausea, vomiting, headache, back pain and FEVER (white cell rxns are most common cause of fever in transfusions). Found in patients with multiple pregnancies or transfusions. Antipyretics should correct the fever and the patient can receive leuko-reduced blood.
Nonimmune-mediated Transfusion Rxn
Disease transmission, circulatory overload, hypothermia, hyperkalemia, and hypocalcemia
Rh HDFN Lab Findings
Positive DAT, increased serum bilirubin
Rhogam
Given to mothers so they do not develop alloantibodies to fetus’ RBCs
3 Classes of HDFN
Caused by 1. Anti-D 2. antibodies against antigens in other systems (ie. anti-c and anti-K). 3. anti-A or anti-B in a group O woman
ABO HDN (Cause, Treatment)
A or B babies born to an O mother, treated with phototherapy to break down excess bilirubin
Predicting HDN
ABO/D on mother prior to delivery, along with Ab screen
Confirming Suspected HDN
Testing of cord blood in those born to D(-) mothers, for ABO, D, and DAT
Cross-match
Determine compatibility of donor blood to patient’s blood
Compatibility
- Review of patient’s past blood bank history and records 2. ABO and Rh grouping of the recipient and donor
- Antibody screening of the recipient’s plasma
- The crossmatch.
Ab ID, ABO-Rh confirmation of donor cells, screening for antigens to known patient antibodies, and the transfusion; requires comparison of current work-up with any other work-ups from the same patient within the last 12 months; ABO and Rh (-) is repeated on all units from BB
Maximum Surgical Blood Order Schedule (MSBOS)
Preformed according to the surgery the patient is having, choosing type and screen, cross-matching for two units, four units, or six units. Represents a a maximum, not minimum order.
Gels
Uses dextran acrylamide gel with reagent or diluent. Anti-IgG cards are used for DATs and IATs
When are Antibody Screens done?
Detects antibodies to specific antigens, used for pregnant women, pre-transfusion, donors, and in transfusion reactions
IgM
Directly bind RBCs and activate complement, react at RT and below, usually clinically insignificant
Include Anti-A and Anti-B
IgG
Cannot agglutinate RBCs, cannot activate complement without two molecules being present, react at 37C, cause transfusion reactions and HDN
