Transfusion reactions

Question 1

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

Answer 1

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

Question 2

What will the blood bank do>

Answer 2

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

Question 3

What percentage of transfusions will have an allergic transfusion reaction?

Answer 3

1-3%

Question 4

What is an allergic transfusion reaction due to?

Answer 4

hypersensitivity to plasma proteins, usually cause unkown

Question 5

How should you treat an allergic transfusion reactions?

Answer 5

antihistamine and possibly steroids if it’s just mild

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

Question 6

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

Answer 6

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

Question 7

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

Answer 7

IgA deficiency (because they can develop antibodies against IgA)

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

Question 8

Acute hemolytic reaction occurs by definition within ___

Answer 8

4 hrs

but will probably happen sooner

Question 9

What is the cause of hemolytic transfusion reactions?

Answer 9

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

Question 10

WHen does a delayed hemolytic transfusion reaction usually occur?

Answer 10

usually 5-14 days after a transfusion

Question 11

A delayed reaction is usually due to what?

Answer 11

formation of a new antibody

OR

there was an amnestic response to Kidd or another antibody group

Question 12

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

Answer 12

1%

Question 13

What’s the presentation of a febrile nonhyemolytic TR?

Answer 13

fever with chills/rigors and nothing else

Question 14

WHat’s the cause of a febrile nonhemolytic TR?

Answer 14

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

Question 15

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

Answer 15

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

Question 16

What is transfusion related acute lung injury?

Answer 16

• 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

Question 17

TRALI wins the prize for what?

Answer 17

the #1 cause of transfusion-related fatality

maybe 1 in 5000 (old number)

Question 18

What are the two theories for TRALI?

Answer 18

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

Question 19

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

Answer 19

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

Question 20

WHat is transfusion-associated circulatory overload

Answer 20

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

just support them through it

Question 21

Which one: TACO or TRALI will respond to a diuretic

Answer 21

just TACO

interestingly, TRALI won’t respond

Question 22

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

Answer 22

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

Question 23

WHat is the cause of post-transfusion purpura?

Answer 23

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

Question 24

How will transfusion associated GVH disease present?

Answer 24

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

Question 25

WHen does transfusion associated GVH disease usually present?

Answer 25

4-30 days post transfusion

Question 26

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

Answer 26

``` 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) ```

Question 27

What is alloimmunization?

Answer 27

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

Question 28

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

Answer 28

``` Hep B Hep C HIV HTLV1 and 2 syphilis west nile CMV bacterial testing of platelets ```

Question 29

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

Answer 29

they need to be stored at room temperature why we spin them and why we can only keep them for 5 days

Question 30

How does a sepsis reaction present?

Answer 30

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

Question 31

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

Answer 31

usually skin commensals but also asymptomatic bacteremia in the donor or manufacturing problems

Question 32

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

Answer 32

``` 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) ```

Question 33

What is the current risk for HIV transfusion transmission?

Answer 33

1 in about 2,000,000 also for HCV

Question 34

What is the current risk for HBV transfusion transmission?

Answer 34

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

Question 35

How can we avoid CMV transmission?

Answer 35

leukoreduce, since CMV lives in WBCs

Question 36

What is the main parasite transfusion transmission we worry about here

Answer 36

babesia

Question 37

Wjat are some other complications of transfusions?

Answer 37

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