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Labs Medicine > Transfusion reactions > Flashcards

Transfusion reactions Flashcards

1
Q

What do you do if you suspet an acute transfusion reaction?

A

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

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2
Q

What will the blood bank do>

A
  1. clerical check
  2. repeat ABO type and screen
  3. DAT
  4. Check serum color (pink-red for hemolysis if it was yellow pre-transfusion)
  5. Sometimes: repeat antibody screen, gram stain, culture the unit, and do LDH, bilirubin, haptoglobin
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3
Q

What percentage of transfusions will have an allergic transfusion reaction?

A

1-3%

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4
Q

What is an allergic transfusion reaction due to?

A

hypersensitivity to plasma proteins, usually cause unkown

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5
Q

How should you treat an allergic transfusion reactions?

A

antihistamine and possibly steroids if it’s just mild

if it proceeds to anaphylaxis, obviously epi, trendelenburg, antihistamings, steroids,

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6
Q

If the reaction is only mild (just hives) and resolves with with benadryl, can you restart the transfusion?

A

yes - this is the ONLY instance where a transfusion can be restarted after a reaction

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7
Q

What group of patients with an immune deficiency can have a severe allergic reaction to blood products?

A

IgA deficiency (because they can develop antibodies against IgA)

so send an IgA level if someone has a severe allergic reaction

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8
Q

Acute hemolytic reaction occurs by definition within ___

A

4 hrs

but will probably happen sooner

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9
Q

What is the cause of hemolytic transfusion reactions?

A

due to the presence of a preformed antibody, usually ABO incompatibiltiy due to clerical error

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10
Q

WHen does a delayed hemolytic transfusion reaction usually occur?

A

usually 5-14 days after a transfusion

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11
Q

A delayed reaction is usually due to what?

A

formation of a new antibody

OR

there was an amnestic response to Kidd or another antibody group

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12
Q

What percentage of transfusions will result in a febrile nonhemolytic transfusion reaction?

A

1%

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13
Q

What’s the presentation of a febrile nonhyemolytic TR?

A

fever with chills/rigors and nothing else

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14
Q

WHat’s the cause of a febrile nonhemolytic TR?

A

there are either cytokines in the stored unit or antibodies in recipient plasma to antigens on donor lymphocytes, granulocytes, platelets, etc.

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15
Q

What are some causes of rspiratory distress associated with a transfusion?

A 
TACO
TRALI
Hemolytic rxn
transfusion associated sepsis
anaphylacic/anaphylactoid
coincidental with underlying condition like COPD, asthma, anxiet, etc.
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16
Q

What is transfusion related acute lung injury?

A
  • 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
17
Q

TRALI wins the prize for what?

A

the #1 cause of transfusion-related fatality

maybe 1 in 5000 (old number)

18
Q

What are the two theories for TRALI?

A

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

19
Q

What public health measure led to a decreased rate of TRALI?

A

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

20
Q

WHat is transfusion-associated circulatory overload

A

it’s in the name - volume overload with no clear definition occuring within several hours of a transfusion

just support them through it

21
Q

Which one: TACO or TRALI will respond to a diuretic

A

just TACO

interestingly, TRALI won’t respond

22
Q

What is post-transfusion purpura and when does it occur?

A

acute severe onset of thrombocytopenia usually 3-10 days post-transfusion

23
Q

WHat is the cause of post-transfusion purpura?

A

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

24
Q

How will transfusion associated GVH disease present?

A

rash, diarrhea, liver abnormalities, pancytopenia (bone marrow aplasia)

25
Q

WHen does transfusion associated GVH disease usually present?

A

4-30 days post transfusion

26
Q

What are the indications for irradiating blood to avoid GVH disease?

A 
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)
27
Q

What is alloimmunization?

A

it’s when you develop antibodies from getting a transfusion. we try to avoid this as much as possible

28
Q

Wat are the current infectious testing we do on donated blood?

A 
Hep B
Hep C
HIV
HTLV1 and 2
syphilis
west nile
CMV
bacterial testing of platelets
29
Q

Why are transfusion associated sepsis reactiosn more common with platelet transfusions?

A

they need to be stored at room temperature

why we spin them and why we can only keep them for 5 days

30
Q

How does a sepsis reaction present?

A

fever, hypotension, shock, nausea, vomiting, respiratory symptoms, coagulopathy

31
Q

What is the usual source of contamination causing the sepsis reactions?

A

usually skin commensals

but also asymptomatic bacteremia in the donor or manufacturing problems

32
Q

How do we reduce the risk for post-transfusion sepsis?

A 
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)
33
Q

What is the current risk for HIV transfusion transmission?

A

1 in about 2,000,000

also for HCV

34
Q

What is the current risk for HBV transfusion transmission?

A

1 in 200,000-500,000 (still the most frequent)

35
Q

How can we avoid CMV transmission?

A

leukoreduce, since CMV lives in WBCs

36
Q

What is the main parasite transfusion transmission we worry about here

A

babesia

37
Q

Wjat are some other complications of transfusions?

A 
hypothermia
citrate toxicity (numbness around lips, toes, fingers - give them calcium)
iron overload
dilutional coagulopathy
electrolyte imbalance
air embolism

Labs Medicine (27 decks)

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