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CLS > Transfusion Reactions > Flashcards

Transfusion Reactions Flashcards

1
Q

Occurs soon after the transfusion of incompatible cells

A

Immediate hemolytic transfusion reaction (IHTR)

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2
Q

Red cells are rapidly destroyed

A

Immediate hemolytic transfusion reaction (IHTR)

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3
Q

Signs and symptoms occurs within minutes or 1-2 hours of transfusion

A

Immediate hemolytic transfusion reaction (IHTR)

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4
Q

What is seen in an IHTR under anesthesia?

A

Hemoglobinuria, abnormal bleeding at surgical wound, and hypotension

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5
Q

What occurs within minutes and causes shock, renal failure, DIC, possible death?

A

ABO incompatible transfusions

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6
Q

What the common antibodies that cause IHTR?

A

Anti-A, anti-K, anti-Jka, anti-Fya

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7
Q

What do the antibodies that cause IHTR do?

A

Anti-A, anti-K, anti-Jka, and anti-Fya bind complement to red cell surfaces and cause in-vitro lysis

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8
Q

What type of hemolysis occurs in an IHTR?

A

Intravascular or Extravascular

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9
Q

What happens during an immediate intravascular hemolytic transfusion reaction?

A

intravascular cell lysis that releases hemoglobin, causing hemoglobinemia and hemoglobineuria

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10
Q

What happens during an immediate extravascular hemolytic transfusion reaction?

A

Ag-Ab complex formation on red cells with incomplete complement activation (no cell lysis)

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11
Q

What are the signs and symptoms caused by IHTR?

A

Fever, chills, chest pain, back pain, hypotension, abdominal pain, hemoglobinemia, hemoglobinuria, etc

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12
Q

What to do when there’s an IHTR?

A

STOP the transfusion, keep IV open with saline, perform clerical checks, return unit, collect appropriate specimens for evaluation

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13
Q

What therapy is done for immediate intravascular hemolytic transfusion reaction?

A

prevent renal failure, treat hypotension with IV, and blood component therapy

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14
Q

immediate extravascular hemolytic transfusion reaction

A

Does not require therapy; just monitor vital signs, coag studies and renal output

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15
Q

How to prevent transfusion reactions?

A

Store red cells only in blood bank monitored refrigerators, never warm cells above 37C, don’t transfuse if patient or donor ID is not accurate

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16
Q

What are the two types of delayed hemolytic transfusion reactions (DHTR)?

A

Secondary response to transfused red cells (3-7 days later) & primary alloimmunization (no past history of preg, transfusion or transplant)

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17
Q

What are the signs and symptoms of DHTR?

A

Complement not activated so no intravascular hemolysis; mild fever, fever with chills, moderate jaundice

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18
Q

What to do when there’s a DHTR?

A

Initiate post-tranfusion reaction protocol (blood speciments should be sent for post-transfusion reaction workup); patient should be observed

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19
Q

What is the therapy for DHTR?

A

Symptomatic anemia should be treated with red cell transfusion

20
Q

What are the 7 immediate non-hemolytic transfusion reactions?

A
  1. Febrile non-hemolytic transfusion reaction (FNHTR)
  2. Allergic
  3. Anaphylactic and Anaphylactoid
  4. TRALI
  5. TACO
  6. Bacterial contamination
  7. Physically or Chemically induced transfusion reaction (PCITR)
21
Q

What causes Febrile?

A

Leukocyte antibodies present in patient’s plasma

22
Q

What units do you give to patients with febrile?

A

RBC-leukocyte reduced

23
Q

How do you treat allergic transfusion reactions?

A

Antihistamines (Benadryl)

24
Q

Is there fever in anaphylactic or anaphylactoid transfusion reactions?

A

No

25
Q

a serious blood transfusion complication characterized by the acute onset of non-cardiogenic pulmonary edema

A

TRALI

26
Q

How do you determine if it’s TRALI?

A

The presence of leukocyte antibodies in transfused plasma

27
Q

What causes TACO?

A

Physician-transfusion reaction when unit is transfused at too fast a rate (they overload in children, elderly and patient with chronic anemia, cardiac disease, thalassemia major or sickle cell disease)

28
Q

What should you do if patient has a history of TACO?

A

Transfuse at 100 mL/hr or less

29
Q

Sepsis, dryness and flushing of patient skin, fever, hypotension, shaking chills, muscle pain, vomiting, cramps, bloody diarrhea

A

Symptoms of bacterial contamination

30
Q

dyspnea, coughing, cyanosis, orthopnea, chest discomfort, headache, restlessness, tachycardia, systolic hypertension, and abnormal EKG results

A

Symptoms of TACO

31
Q

chills, cough, fever (one of the few to have fever), cyanosis, hypotension, and increasing respiratory distress shortly after transfusion of blood components

A

Symptoms of TRALI

32
Q

Ranges from hives and itching to shock and death

A

Symptoms of Anaphylactic and Anaphylactoid Reactions

33
Q

Swelling and raised red welts that may itch, fever may or may not be present

A

Symptoms of allergic transfusion reactions

34
Q

fever with or without chills, rarely hypotension, most symptoms are mild and benign, severe reactions: hypotension, cyanosis, tachycardia, tachypnea, dyspnea, cough, limited fibrinolysis and transient leukopenia

A

Symptoms of febrile

35
Q

facial numbness, chills, generalized numbness, muscle twitching, cardiac arrhythmias, nausea, vomiting, anxiety

A

Symptoms of PCITR

36
Q

What happens to RBCs in PCITR?

A

Physical damage to RBCs leading to abnormal cells

37
Q

How do you avoid PCITR?

A

Precautionary measures

38
Q

What are the 5 delayed non-hemolytic transfusion reactions?

A
  1. Alloimmunization
  2. Post-transfusion purpura (skin hemorrhages)
  3. Transfusion-Associated Graft vs. Host Disease (TA-GVHD)
  4. Iron Overload
  5. Immunosuppression
39
Q

What are the immediate lab procedures after transfusion reaction?

A
  • Clerical checks
  • Visual inspection of serum and plasma for free hemoglobin and hemolysis (pre and post transfusion)
  • DAT on POST TRANSFUSION SPECIMEN
40
Q

What are the “as required” procedures after transfusion reaction?

A
  • ABORh on pre and post
  • Crossmatch on pre and post
  • ABS on pre and post
  • ABID
  • Antigen typing
  • Check for free hemaglobin in first voided urine post
  • Check for unconjugated bilirubin 5-7 hours post-transfusion
41
Q

What are the extended procedures after transfusion reaction?

A
  • Gram stain and bacterial culture
  • Serum hgb
  • Serial hgb, hct, and platelet count
  • Peripheral blood smear
42
Q

What happens if there’s a positive DAT in post-transfusion specimen?

A

Perform an elution and determine specificity; repeat DAT on several specimens to detect rising antibody titers

43
Q

What happens if there’s a negative DAT in post-transfusion specimen?

A

If there’s hemolysis, perform an elution; repeat DAT later on a new specimen

44
Q

What if there’s too few antibody molecules to detect in a negative DAT?

A

Elution and concentrate antibody

45
Q

What causes false negative antibody screens?

A
  • Failure to detect alloantibody in original test
  • Test not sensitive enough to detect alloantibody
  • Clerical or technical error
  • Antibody screening cells represented a single dose of antigen
  • Antibody identified in post only (due to anamnestic response or patient ID problem)
46
Q

What do you check for in first voided post-transfusion urine?

A

Free hemoglobin (hemoglobinuria)

47
Q

What do you check for in the post-transfusion urine one week later?

A

hemosiderinuria

CLS (6 decks)

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