Transfusion Reactions Flashcards
Diverse group of unfavorable transfusion related events taht occur during or after transfusion of blood and blood components
Transfusion reactions
Which transfusion rxn occurs w/ the transfusion of incompatible RBCs (most common) or plasma products that is immune mediated and results in intravascular or extravascular hemolysis?
Hemolytic transfusion reactions
Which transfusion rxn occurs where the immune system is a common pathway but intravascular and extravascular hemolysis doesn’t occur?
Nonhemolytic transfusion reaction
Immediate/acute transfusion rxn occurs when?
During or w/in 24 hours of transfusion
Delayed transfusion rxn occurs when?
Several days to weeks after transfusion
List the two hemolytic reactions
- Acute intravascular (ABO Abs)
2. Delayed extravascular (IgG Abs)
List the 5 immediate nonhemolytic rxns
- Febrile
- Allergic/anaphylactic
- TRALI
- TACO
- Bacterial
List the 5 delayed nonhemolytic rxns
- Alloimmunization
- Post transfusion purpura (PTP)
- Transfusion-related GVHD
- Iron overload
- Disease transmission
Abs associated w/ IHTRs and DHTRs
IHTRs: intravascular → IgM (ABO)
DHTRs: extravascular → IgG (Rh, Kell, Kidd, Duffy, SsU)
What is the most common cause of preventable hemolytic transfusion reactions?
Clerical error
Bedside procedures in the event of a suspected transfusion reaction (8)
- STOP TRANSFUSION
- Clerical check
- Call MD
- Call BB
- Draw EDTA
- Send EDTA, donor bag, tubing paperwork, and order to BB
- Send 1st UA if AHTR is suspected
- Keep IV lines open
Describe steps to follow in a lab investigation of a suspected transfusion reaction
- Clerical check and attached solution
- Centrifuge post-transfusion sample to assess for visual hemoglobinemia (compre to pre-transfusion sample)
- DAT performed on post-transfusion EDTA sampel
- Additional workup based on results of the above 3 items AND clinical symptoms of patient
- Perform DAT
- If >2°C temp rise, send bag to micro for culture
Why will a DAT will be either positive or negative in an acute HTR?
Negative if there is not an Ab-Ag rexn and positive if there is!
What is the characteristic appearance of the DAT when an acute or delayed HTR has occurred?
Positive/hemolyzed
Explain why a IAT on a post-reaction serum sample may be negative following the infusion of Ag positive blood to an individual w/ corresponding Ab
?
Most common transfusion-associated disease
Hepatitis
If a patient should come down with Hepatitiis or HIV suspected to be due to blood transfusion, the hospital should follow a reporting process. Hospital > notifies Blood center > notifies donor > gets retested > and Blood center > notifies hospital of results > notifies other facilities that used products
“Look-back” process
What 2 tests are diagnostic for a transfusion reaction?
- DAT
- Visual hemoglobin
Abnormally rapid heart rate
Tachycardia
Shortness of breath (SOB)
Dyspnea
FNHTR
Febrile nonhemolytic transfusion reaction
TRALI
Transfusion related acute lung injury
TACO
Transfusion associated circulatory overload
PTP
Post-transfusion (thrombocytopenic) purpura
TA-GVHD
Transfusion-associated graft vs. host disease
A rash of round, red welts on the skin that itches intensely, sometimes w/ dangerous swelling, caused by an allergic reaction, typically to specific foods
Urticaria
Unpleasant sensation of the skin that provokes the urge to scratch. It’s a characteristic feature of many skin diseases and an unusual sign of some systemic diseases
Pruritis
Superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilation of the blood capillaries
Erythema
An immune response generated in an individual or strain of one species by an alloantigen from a different individual or strain of the same species
Alloimmunization
Accumulation of iron in the liver and/or heart but also endocrine organs, in patients who recieve frequent blood transfusions (such as those w/ thalassemia, sickle cell disease, aplastic anemia or MDS)
Transfusion hemosiderosis
“White-out” caused by changes in permeability of the pulmonary capillary membrane as a result of either a direct or an indirect pathologic insult
Noncardiogenic pulmonary edema
Condition that occurs due to a rapid transfusion of a large volume of blood
Circulatory overload
Therapy for an allergic reaction
Antihistamines (Benadryl)
Therapy for febrile reaction
Acetaminophen
Therapy for anaphylactic reaction
Epinephrine
Therapy for febrile reaction w/ ↓ platelets
Acetaminophen
Therapy for bacterial contamination reaction
Broad spectrum antibiotics
Therapy for urticaria reaction
Antihistamines (Benadryl)
Therapy for iron overload
Desferrioxamine (iron-chelating agent)
Cause of immediate HTR
ABO Abs
Therapy for TACO
- Oxygen therapy
- Diuretics/digoxin
- Slow transfusion
Cause of delayed HTR
Anti-Jka
Cause of febrile reaction
HLA Abs present in patient’s plasma
Cause of allergic reaction
Patient’s reaction to transfused plasma proteins of donor
Cause fo anaphylactic reaction
Recipient lacks IgA and has anti-IgA Abs
Cause of TRALI
Donor or recipient has anti-HLA Abs and female plasma donors (multiple pregnancies, therefore multiple exposures to foreign HLA/neutrophil Ags)
Cause of TACO
Transfusion is too fast → volume overload
Cause of bacterial contamination
- Yersinia enterocolitica (most common), E. coli, and Pseudomonas spp. prefer to grow in RBCs
- GPCs (Staphylococcus and Streptococcus) like the warm environment provided by platelets
Cause of post-transfusion purpura (PTP)
Involves Ab to platelet Ag, usually HPA-1A (almost everyone positive for Ag) → anti-PL^A1
Cause of TA-GVHD
Donor T lymphocytes attack recipient
Cause of iron overload
Complication of long-term RBC transfusions → “transfusion hemosiderosis”
Alternate name for immediate HTR
Acute intravascular reaction
Alternate name for delayed HTR
Delayed extravascular reaction
Alternate name for febrile reaction
FNHTR
Alternate name for allergic reaction
Urticarial reaction
Alternate name for TRALI
Noncardiogenic pulmonary edema
Alternate name for TACO
Circulatory overload
Alternate name for iron overload
Transfusion hemosiderosis
Blood product for delayed HTR
Ag negative RBCs
Blood product for febrile reaction
Leukoreduced products
Blood product for allergic reaction
Washed or frozen RBCs
Blood product for anaphylactic reaction
Washed or deglyc’d RBCs or IgA deficient products
Blood product for TRALI
Plasma from male donors
Blood product for TA-GVHD
Irradiated products
Fever, bleeding, tachycardia, hypotension, low back pain, dyspnea, hemoglobinuria, feeling of “impending doom”, death
Immediate hemolytic
Fever/chils, mild jaundice, anemia
Delayed hemolytic
↑ temperature > or equal to 1°C or 2°F, chills
Febrile (non-hemolytic)
Urticaria, pururitis, flushing
Allergic reaction
Severe dyspnea, tachycardia, hypotension
Anaphylactic
Dyspena, chills, fever, HYPOtensive, pulmonary edema, “white out”
TRALI
Dyspnea, cyanosis, pulmonary edema, HYPERtension
TACO
Rapid onset of high fever, sepsis (bacteremia w/ concomitant hypotension, DIC), violent rigors, dyspnea, shock, death
Bacterial contamination
Thrombocytopenia
Post-transfusion purpura (PTP)
Skin (rash and/or sloughing off of skin), GI (diarrhea), BM (pancytopenia), Hepatitis, dermatitis, enteritis
TA-GVHD
Accumulation of iron affects function of heart, liver, and endocrine glands
Iron overload
LAB: DAT+, hemoglobinemia, ↑ bili and LDH, ↓ haptoglobin, hemoglobinuria
Immediate hemolytic
LAB: DAT+, IAT+, spherocytes
Delayed hemolytic
Febrile (nonhemolytic), allergic, anaphylactic, TRALI, TACO, and TA-GVHD are ONLY DAT ____
Negative
LAB: product discolored, patient DAT negative, hemoglobinemia, hemoglobinuria, and culture product positive
Bacterial contamination
LAB: extremely low platelet count, DAT negative
PTP
LAB: DAT negative, diagnosed w/ ferritin levels
Iron overload
