Transfusion risk and reactions Flashcards
2 main blood infections from 70s and 80s
HIV and hepC
5 key points to informed consent
- obtained by treating phys
- mandatory except emergecy and no decision maker
- benefit, risk, alt. discussed
- documented
- advise patient what was given after
what is most common risk
transfusion associated circ. overload
- 3 things patients worry about
HIV, hep B and C
- 1/millions
what are most common
fever and hives
what are most common cause of death
TACO - circ overload
2. TRALI - trans assoc. acute lung injury
4 Sx occuring during or shortly after
- fever
- uritcaria
- dyspnea
- hypotension
def. fever and DDx (4)
1degree rise and temp over 38
- acute hemolytic transfusion rxn (AHTR)
- bact.
- febrile non-hemolytic trans. rxn
- fever due to underlying illness
mech. and manifestation of AHTR
mech - incompatibility of donor and recip. manif - fever, chills - hemouria, pain, hypotension, N/V, DIC
MGMT of AHTR
- stop trans!
- check clerical errors
- notify blod bank
- send samples to recheck PT blood type
- send labs to look for hemolysis
- supportive care
potential causes of bact.
- normal skin flora
- bacteremia in donor
- contamination in handling
- most often platelets (room temp)
Sx of bact
- fever, chills
- hemouria, pain, hypotension, N/V, DIC
mgmt of bact
- stop trans
- notify bank and send back bloods
- culture Pt
- broad spectrum ABs
mech of febrile non-hemolytic trans. rxn
- cytokines in transfused products
- recipietn ABs in the transfused product
manif of febrile non-hemolytic trans. rxn
fever
- maybe worse
- diag. of exclusion
mgmt of febrile non-hemolytic trans. rxn
- pause transfusion
- give tylonol
- f resolves, can continue
DDx for urticaria (3)
- anaphylaxis/major
- minor allergic rxn
- from another cause (food/drugs)
mech of anaphylaxis
- most unexplained
- possible recipient has IgG agains missing protein
- passive IgE from donor
- transfusion of allergen from donor
manif of anaphlaxis
- cutaneous almost always
- rash, hives, pruririts
- wheeze, stridor
- hypotension, chest pain, tachy
mgmt of anaphlaxis
- stop trans
- admin benadryl
- if ana, then epi, corticosteroids, pressors
mgmt of minor allergy
- bendryl (diphenhydramine)
- restart if hives
DDx of dyspnea (4)
- TACO
- TRALI
- major allergy
- not related to transfusion
mech of TACO
- volume overload
- too much to fast
- risk like CHF, eldeely, renal dys
manif of TACO
- orthopnea, cyanosis, HR BP JVP all UP
- volume overload on CXR
mgmt of TACO
- stop trans
- CXR
- supportive care
prevention of TACO
one unit at a time over 3.5 hours
- furosemide in PT > 60 or CHF
what is TRALI
tran. related acute lung injury
- non-cardiogenic pulm. edem
- w/in 6 hours
- new acute lung injury
- bilateral infiltrates on CXR
-
manif of TRALI
dyspnea, hypoxia, fever, hypotension
mgmt of TRALI
- stop
- inform transfusion med. lab
- CXR
- supportive care
what are sexes for TRALI prevention
male plasma
male or female buffy coat
def. hypotension
drop of 30 in syst. or distolic
DDx of hypotension (6)
TRALI anaphlaxis bact AHTR severe FNHTR bradykinin mediated
mgmt of hypotension
- stop
- fluids
- rarely has sig. morbidity
4 delayed rxns
DHTR
PTP
TaGVHD
TTI
what is hemolytic transfusion rxn
due to formation of ABs to transfused RBCs that weren’t originally found
- 3 days to 2 weeks
- need to ID and tell Pt so not given more
