Transfusion Reactions Flashcards
Occurs soon after the transfusion of incompatible cells
Immediate hemolytic transfusion reaction (IHTR)
Red cells are rapidly destroyed
Immediate hemolytic transfusion reaction (IHTR)
Signs and symptoms occurs within minutes or 1-2 hours of transfusion
Immediate hemolytic transfusion reaction (IHTR)
What is seen in an IHTR under anesthesia?
Hemoglobinuria, abnormal bleeding at surgical wound, and hypotension
What occurs within minutes and causes shock, renal failure, DIC, possible death?
ABO incompatible transfusions
What the common antibodies that cause IHTR?
Anti-A, anti-K, anti-Jka, anti-Fya
What do the antibodies that cause IHTR do?
Anti-A, anti-K, anti-Jka, and anti-Fya bind complement to red cell surfaces and cause in-vitro lysis
What type of hemolysis occurs in an IHTR?
Intravascular or Extravascular
What happens during an immediate intravascular hemolytic transfusion reaction?
intravascular cell lysis that releases hemoglobin, causing hemoglobinemia and hemoglobineuria
What happens during an immediate extravascular hemolytic transfusion reaction?
Ag-Ab complex formation on red cells with incomplete complement activation (no cell lysis)
What are the signs and symptoms caused by IHTR?
Fever, chills, chest pain, back pain, hypotension, abdominal pain, hemoglobinemia, hemoglobinuria, etc
What to do when there’s an IHTR?
STOP the transfusion, keep IV open with saline, perform clerical checks, return unit, collect appropriate specimens for evaluation
What therapy is done for immediate intravascular hemolytic transfusion reaction?
prevent renal failure, treat hypotension with IV, and blood component therapy
immediate extravascular hemolytic transfusion reaction
Does not require therapy; just monitor vital signs, coag studies and renal output
How to prevent transfusion reactions?
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
What are the two types of delayed hemolytic transfusion reactions (DHTR)?
Secondary response to transfused red cells (3-7 days later) & primary alloimmunization (no past history of preg, transfusion or transplant)
What are the signs and symptoms of DHTR?
Complement not activated so no intravascular hemolysis; mild fever, fever with chills, moderate jaundice
What to do when there’s a DHTR?
Initiate post-tranfusion reaction protocol (blood speciments should be sent for post-transfusion reaction workup); patient should be observed
What is the therapy for DHTR?
Symptomatic anemia should be treated with red cell transfusion
What are the 7 immediate non-hemolytic transfusion reactions?
- Febrile non-hemolytic transfusion reaction (FNHTR)
- Allergic
- Anaphylactic and Anaphylactoid
- TRALI
- TACO
- Bacterial contamination
- Physically or Chemically induced transfusion reaction (PCITR)
What causes Febrile?
Leukocyte antibodies present in patient’s plasma
What units do you give to patients with febrile?
RBC-leukocyte reduced
How do you treat allergic transfusion reactions?
Antihistamines (Benadryl)
Is there fever in anaphylactic or anaphylactoid transfusion reactions?
No
a serious blood transfusion complication characterized by the acute onset of non-cardiogenic pulmonary edema
TRALI
How do you determine if it’s TRALI?
The presence of leukocyte antibodies in transfused plasma
What causes TACO?
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)
What should you do if patient has a history of TACO?
Transfuse at 100 mL/hr or less
Sepsis, dryness and flushing of patient skin, fever, hypotension, shaking chills, muscle pain, vomiting, cramps, bloody diarrhea
Symptoms of bacterial contamination
dyspnea, coughing, cyanosis, orthopnea, chest discomfort, headache, restlessness, tachycardia, systolic hypertension, and abnormal EKG results
Symptoms of TACO
chills, cough, fever (one of the few to have fever), cyanosis, hypotension, and increasing respiratory distress shortly after transfusion of blood components
Symptoms of TRALI
Ranges from hives and itching to shock and death
Symptoms of Anaphylactic and Anaphylactoid Reactions
Swelling and raised red welts that may itch, fever may or may not be present
Symptoms of allergic transfusion reactions
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
Symptoms of febrile
facial numbness, chills, generalized numbness, muscle twitching, cardiac arrhythmias, nausea, vomiting, anxiety
Symptoms of PCITR
What happens to RBCs in PCITR?
Physical damage to RBCs leading to abnormal cells
How do you avoid PCITR?
Precautionary measures
What are the 5 delayed non-hemolytic transfusion reactions?
- Alloimmunization
- Post-transfusion purpura (skin hemorrhages)
- Transfusion-Associated Graft vs. Host Disease (TA-GVHD)
- Iron Overload
- Immunosuppression
What are the immediate lab procedures after transfusion reaction?
- Clerical checks
- Visual inspection of serum and plasma for free hemoglobin and hemolysis (pre and post transfusion)
- DAT on POST TRANSFUSION SPECIMEN
What are the “as required” procedures after transfusion reaction?
- 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
What are the extended procedures after transfusion reaction?
- Gram stain and bacterial culture
- Serum hgb
- Serial hgb, hct, and platelet count
- Peripheral blood smear
What happens if there’s a positive DAT in post-transfusion specimen?
Perform an elution and determine specificity; repeat DAT on several specimens to detect rising antibody titers
What happens if there’s a negative DAT in post-transfusion specimen?
If there’s hemolysis, perform an elution; repeat DAT later on a new specimen
What if there’s too few antibody molecules to detect in a negative DAT?
Elution and concentrate antibody
What causes false negative antibody screens?
- 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)
What do you check for in first voided post-transfusion urine?
Free hemoglobin (hemoglobinuria)
What do you check for in the post-transfusion urine one week later?
hemosiderinuria
