Transfusion reactions Flashcards
What do you do if you suspet an acute transfusion reaction?
STOP the infusion, but keep the IV line open so you can give fluids and other meds
report to the blood bank
return the unused portion to the blood bank and send additional specimens as necessary
What will the blood bank do>
- clerical check
- repeat ABO type and screen
- DAT
- Check serum color (pink-red for hemolysis if it was yellow pre-transfusion)
- Sometimes: repeat antibody screen, gram stain, culture the unit, and do LDH, bilirubin, haptoglobin
What percentage of transfusions will have an allergic transfusion reaction?
1-3%
What is an allergic transfusion reaction due to?
hypersensitivity to plasma proteins, usually cause unkown
How should you treat an allergic transfusion reactions?
antihistamine and possibly steroids if it’s just mild
if it proceeds to anaphylaxis, obviously epi, trendelenburg, antihistamings, steroids,
If the reaction is only mild (just hives) and resolves with with benadryl, can you restart the transfusion?
yes - this is the ONLY instance where a transfusion can be restarted after a reaction
What group of patients with an immune deficiency can have a severe allergic reaction to blood products?
IgA deficiency (because they can develop antibodies against IgA)
so send an IgA level if someone has a severe allergic reaction
Acute hemolytic reaction occurs by definition within ___
4 hrs
but will probably happen sooner
What is the cause of hemolytic transfusion reactions?
due to the presence of a preformed antibody, usually ABO incompatibiltiy due to clerical error
WHen does a delayed hemolytic transfusion reaction usually occur?
usually 5-14 days after a transfusion
A delayed reaction is usually due to what?
formation of a new antibody
OR
there was an amnestic response to Kidd or another antibody group
What percentage of transfusions will result in a febrile nonhemolytic transfusion reaction?
1%
What’s the presentation of a febrile nonhyemolytic TR?
fever with chills/rigors and nothing else
WHat’s the cause of a febrile nonhemolytic TR?
there are either cytokines in the stored unit or antibodies in recipient plasma to antigens on donor lymphocytes, granulocytes, platelets, etc.
What are some causes of rspiratory distress associated with a transfusion?
TACO TRALI Hemolytic rxn transfusion associated sepsis anaphylacic/anaphylactoid coincidental with underlying condition like COPD, asthma, anxiet, etc.
What is transfusion related acute lung injury?
- acute onset within 6 hrs of transfusion
- acut elung injury with hypoxemia, bilateral infiltrates on CXR, no evidence of left arterial hypertension (circluatory overload; because that would be TACO, not TRALI) with NO OTHER CAUSE for acute lung injury
TRALI wins the prize for what?
the #1 cause of transfusion-related fatality
maybe 1 in 5000 (old number)
What are the two theories for TRALI?
Immune: donor has antibodies to recipient human neutrophil antigens and forms a soluble complex that activates complement and inflammation
Non-immune: they have a pre-existing condition that activates neutrophils and then the transfused blood has accumulated lipids that further activate the primed neutrophils
What public health measure led to a decreased rate of TRALI?
we found out that most cases were coming from cases where the donor was female (and females have more antibodies)
so we’ve switched to allowing only males and proven nullip females
WHat is transfusion-associated circulatory overload
it’s in the name - volume overload with no clear definition occuring within several hours of a transfusion
just support them through it
Which one: TACO or TRALI will respond to a diuretic
just TACO
interestingly, TRALI won’t respond
What is post-transfusion purpura and when does it occur?
acute severe onset of thrombocytopenia usually 3-10 days post-transfusion
WHat is the cause of post-transfusion purpura?
usually an amnestic response to a platelet antigen that on re-exposure will cause removal of both transfused and SELF platelets
this is very rare
How will transfusion associated GVH disease present?
rash, diarrhea, liver abnormalities, pancytopenia (bone marrow aplasia)
WHen does transfusion associated GVH disease usually present?
4-30 days post transfusion
What are the indications for irradiating blood to avoid GVH disease?
neonates congenital immunodef all peds onc patients stem cell transplants hodgkin's on purine analog drugs in the past 12 months for intrauterine transfusions for granulocyte transfusions Directed donations from family members (higher risk for GVHD)
What is alloimmunization?
it’s when you develop antibodies from getting a transfusion. we try to avoid this as much as possible
Wat are the current infectious testing we do on donated blood?
Hep B Hep C HIV HTLV1 and 2 syphilis west nile CMV bacterial testing of platelets
Why are transfusion associated sepsis reactiosn more common with platelet transfusions?
they need to be stored at room temperature
why we spin them and why we can only keep them for 5 days
How does a sepsis reaction present?
fever, hypotension, shock, nausea, vomiting, respiratory symptoms, coagulopathy
What is the usual source of contamination causing the sepsis reactions?
usually skin commensals
but also asymptomatic bacteremia in the donor or manufacturing problems
How do we reduce the risk for post-transfusion sepsis?
donor screening skin prep diversion of initial blood draw bacterial detection pathogen inactivation (treat platelets with a chemical that will percolate into every cell with DNA - COOL! won't affect the platelet)
What is the current risk for HIV transfusion transmission?
1 in about 2,000,000
also for HCV
What is the current risk for HBV transfusion transmission?
1 in 200,000-500,000 (still the most frequent)
How can we avoid CMV transmission?
leukoreduce, since CMV lives in WBCs
What is the main parasite transfusion transmission we worry about here
babesia
Wjat are some other complications of transfusions?
hypothermia citrate toxicity (numbness around lips, toes, fingers - give them calcium) iron overload dilutional coagulopathy electrolyte imbalance air embolism
