transfusion rxn Flashcards
non hemolytic rxns examples
febrile
allergic
anaphylactic
TACO
TRALI
GVHD
transfusion transmitted disease
alloimmunization
transfusion induced hemosiderosis
PTP
hemolytic transfusion rxn examples
immediate intravascular hemolysis
immediate extravascular hemolysis
delayed extravascular hemolysis
non hemolytic transfusion rxn overview
96% of all rxns
febrile non hemolytic transfusion rxn
> 1 degree C rise in temp
1% of transfusions
caused by anti-WBC Ab
fever, chills
use leukoreduced products
allergic non hemolytic trans rxns
rxn to donor plasma
20% of all rxns
itching, hives, edema
use plasma free products
anaphylactic non hem. trans. rxns
allo anti-IgA Ab
mild allergic rxn, shock, death
use plasma free prods, IgA free
TACO non hem. trans. rxn
transfusion associated circulatory overload
chest pain, dyspnea, cough, heart failure
infuse more slowly
TRALI non hem. trans, rxn
anti-WBC Ab
damage to lung tissue
chills, cough, fever, respiratory failure
graft vs host disease trans rxn
donor Tcells attack immunocompromised patient
pancytopenia, fever, abn. liver fxn
give irradiated products
transfusion transmitted disease
hepatitis
HIV
HTLV
west nile virus
CMV & EB
Malaria
babesiosis
chaga’s disease
toxoplasmosis
rocky mt. spotted fever
syphilis
transfusion induced hemosiderosis
iron overload
PTP
post transfusion purpura
platelet allo-antibodies
depletion of plts and coag factors
complications associated with massive transfusion
citrate toxicity
hypothermia
dilutional thrombocytopenia
hemolytic transfusion rxns overview
4% of rxns
intravascular vs extravascular
immediate vs delayed
immediate intravascular hemolysis
IgM complement activating Ab
IgG Ab
ABO mix up
within 2 hrs: fever, chills, renal shutdown, DIC, hemoglobinemia
10% mortatlity
supportive treatment
immediate extravascular hemolysis
occurs within 2 hrs
fever, chills, renal shutdown, DIC, NO HEMOGLOBINEMIA
Delayed extravascular hemolysis
anamnestic response or Ab production
Rh Ab
Anti-Jka
Anti-K
Anti-Fya
3-7 days post transfusion, hgb/hct decrease, mild sx fever chills jaundice
supportive treatment
physical damage to transfused cells
heat damage (warmers, storage)
physical damage (pumps, heart valves)
microbe contamination of donor units- most common microbes
Yersinia entercolitica
Pseudomonas
E. coli
microbe contamination of donor units
looks brown, purple, chunks
sx: rapid onset, fever, chills, DIC, shock, death
IV Antibiotics
visual inspection of units
evaluation of suspected rxn patient care personnel resposibilities
take vital signs
stop transfusion
keep IV line open
notify Dr & transfusion service
bedside clerical check
document info
treat patient w/ antihistamines- cont. trans or send unit to lab
evaluation of suspected rxn lab personnel resposibilities
clerical check
observe pre and post for hemolysis
serum/plasma Hgb
GS/ culture
DAT on post- if + DAT on pre
proceed to extended eval if hemolysis, or new DAT
extended eval of trans. rxn is needed if…
discrepancy in clerical check
Post DAT+, pre DAT=
visual hemolysis
post serum hgb >20 mg/dl more than pre
extended eval
Pre and Post: ABO/Rh, IAT, Crossmatch
Lab seg from donor unit: ABO/Rh, Ag type if Ab ID’d
urine hgb
serum bilirubin
plasma hgb
haptoglobin
cultures
