Transfusion Reactions Flashcards
Presentation of febrile non-hemolytic transfusion reaction
Isolated fever, no systemic symptoms
AHTR presentation
Fever, hypotension, chills, flank pain, hematuria, nausea/vomiting, and oozing from intravenous sites, “feeling of impending doom”.
How does a urticarial transfusion reaction (UTR) present?
Hives but no other allergic findings (ie, no wheezing, angioedema, hypotension)
Definition of massive transfusion
- 10 units of blood in 24 hours or less
- transfusion of 4 units in 1 hour or less
Transfusion goals with massive transfusion
Platelets greater than 50k
Fibrinogen greater than 100
Transfusion goal with FFP
PT or PTT less than 1.5x mean
Complications of massive transfusion
- hypothermia (blood products stored at cold temperatures)
- hypocalcemia (large volume of citrate in blood components)
- bleeding, coagulopathy (dilutional coagulopathy)
- acidosis
Evidence-based relative components of massive transfusion
1:1:2 (PRBC’s)
Pathophys + how AHTR typically happens
ABO mismatch (clerical error, nurse or someone else misidentifies blood sample and or misidentifies the patient)
Most severe transfusion reaction
- acute hemolytic transfusion reaction
AHTR mechanism
- PRBCs coated with antibody activate complement system, leading to hemolysis and active coagulation and fibrinolytic system
AHTR management
- stop transfusion
- aggressive IV hydration w/ NS w/ added bicarb (renal protection)
- Titrate to urine output >100cc/hr
- alkalinize urine
- Trend UA → goal urine pH > 7.5
- Lasix
- DIC labs
Febrile non hemolytic transfusion reaction mechanism
- patient with anti-WBC antibodies
- OR cytokine accumulation
Febrile non hemolytic transfusion reaction presentation
fever/chills, myalgias, tachycardia, headache
most common transfusion reactions
- allergic
- febrile nonhemolytic
mechanism of urticarial reaction
antibody in patient reacts with donor plasma proteins
OR antibod in donor plasma reacts with patient plasma proteins
management of urticarial reaction + can you rechallenge?
Benadryl
+/- steroids
IF symptoms resolve → resume transfusion at slower rate
mechanism of anaphylactic transfusion reactions
Antibodies to IgA in IgA deficient recipients
TRALI mechanism
- antibodies in donor plasma against patient WBC and or priming lipids
TRALI natural course
Resolves in 24-48 but severe cases can be fatal
TRALI diagnosis
Onset within 6 hours of transfusion + hypoxemia + bilateral infiltrates on CXR + no evidence of volume overload
when delayed hemolytic transfusion reactions typically occur
1-2 weeks after pRBC transfusion
RBC antigens most commonly responsible for DHTRs
kidd or Rh system
Unique lab finding of delayed hemolytic transfusion reaction
- reticulocytopenia (unknown why thought to be peripheral consumption?)
Antigen on RBC’s that parvovirus binds to
P antigen
pathophysiology of acute allergic reaction
antibody reacts with donor plasma proteins
- transfused blood contains IgE that binds to antigen from recipients blood or patient’s IgE binds to antigen in blood product, leading to histamine release from mast cells
Febrile nonhemolytic transfusion reaction pathophys
- antibodies directed against white blood cells HLA in donor blood
OR cytokine release
pathophys of TRALI
- antibodies in donor plasma against a patients white blood cells
Leading cause of transfusion-related mortality in the US
TRALI
mechanism of delayed hemolytic transfusion reaction
- low level antibody to RBC antigen (typically non-ABO)
Cause of platelet refractoriness from alloimmunization
- Antibodies to a donors antigens of the HLA system
Antigen antibody is directed against in post-transfusion purpura
HPA-1a
Most common alloantibody outside of the ABO and Rh group system
Anti-Kell
pathophys of passenger lymphocyte syndrome
Minor mismatch between donor and recipient in ABO system
Definition of major ABO incompatibility in transplant
- naturally occurring antibody in the recipient (eg recipient 0, donor A or B OR recipient A, donor AB)
Definition of minor ABO incompatibility in transplant
- naturally occurring antibody in the donor (recipient A, donor O)
Typical blood groups of mom and baby in hemolytic disease of the newborn
- Group A or B neonates of group O mothers (group O individuals make predominantly IgG (rather than IgM) anti-A and anti-B isohemagglutinins, which can cross the placenta. IgM does not cross the placenta.
Why patients on purine analogues need irradiated blood
- purine analogues induce profound lymphopenia with low CD4 counts, which may persistent for several years after treatment
What are the purine analogues
- fludarabine, cladribine
