W16 - Blood transfusion 2 Flashcards
Adverse reactions to transfusion = time cut off for acute vs delayed
24 hours
<24 hours = acute
>24 hours = delayed
Name 5 types of ACUTE adverse reactions to transfusion
- Acute haemolytic (ABO incompatible)
- Allergic/anaphylaxis
- Infection (bacterial)
- Febrile no-haemolytic
- Respiratory
=> Transfusion associated circulatory overload (TACO)
=> Acute lung injury (TRALI)
=> Transfusion associated dyspnoea (TAD)
Name 5 types of DELAYED adverse reactions to transfusion
- Delayed haemolytic transfusion reaction (antibodies)
- Infection (viral, malaria, vCJD)
- TA GvHD
- Post transfusion purpura
- Iron overload
What 4 things should you measure as baseline when giving transfusion? How frequently should you measure?
1- Temp
2- HR
3- RR
4- BP
repeat after 15 minutes -> repeat hourly and at the end of transfusion
Febrile non-haemolytic transfusion reaction (FNHTR)
- when does it occur?
- what are the symptoms?
- treatment?
Febrile non-haemolytic transfusion reaction (FNHTR)
- when does it occur = during/soon after transfusion (blood or platelets)
- what are the symptoms = rise in temp of 1 degrees C, rigors
- treatment = stop/slow transfusion + paracetamol
Cause of febrile non-haemolytic transfusion reaction (FNHTR)
due to donor white cells remaining in product during storage and releasing cytokines => now RARE due to leucodepletion of donor product
Allergic transfusion reaction:
- when does it occur?
- what are the symptoms?
- treatment?
Allergic transfusion reaction:
- when does it occur = during/after transfusion (esp plasma)
- what are the symptoms = mild urticarial rash with wheeze
- treatment = stop/slow transfusions + IV antihistamines
Cause of allergic transfusion reactions
due to a plasma protein in donor, so it may NOT occur again depending on how common the allergen is
- commoner in recipients with other allergies and atopy
Acute haemolytic reaction (aka wrong blood):
- when does it occur?
- what are the symptoms?
- treatment?
Acute haemolytic transfusion reaction (aka wrong blood):
- when does it occur = within 24 hours
- what are the symptoms = signs of intravascular haemolysis:
- restless
- chest/loin pain
- fever
- vomiting
- flushing
- collapse/shock (BP low, HR high)
- treatment = stop transfusion, check patient/component, take FBC, LFTs, clotting, repeat x-match and direct antiglobulin test (DAT), discuss w/ haematology
In terms of transfusion reactions, what is the #1 reason why they occur?
clerical error!
Bacterial contamination transfusion reaction:
- when does it occur?
- what are the symptoms?
- treatment?
Bacterial contamination transfusion reaction:
- when does it occur = within 24 hours
- what are the symptoms =
- restless
- chest/loin pain
- fever
- vomiting
- flushing
- collapse/shock (BP low, HR high) due to endotoxin release
- treatment = stop + abx + supportive
Which transfusion product is more likely to grow bacteria - red cells or platelets?
Platelets because they are stored at room temp whereas red cells are stored at 4 degrees C
Anaphylactic transfusion reaction:
- when does it occur?
- what are the symptoms?
- treatment?
Anaphylactic transfusion reaction:
- when does it occur = soon after start of transfusion
- what are the symptoms:
- shock (low BP, high HR)
- SOB +/- wheeze
- laryngeal +/- facial oedema
- treatment =
1) stop blood transfusion
2) adrenaline
3) supportive care
4) inhaled bronchodilator + glucagon + antihistamine + corticosteroids
Cause of anaphylactic transfusion reactions
in what disease are anaphylactic transfusion reactions more SEVERE?
IgE abs in patient => mast cell degranulation + vasoactive substance
*more severe in IgA deficiency
What is the most common pulmonary complication of transfusion reaction?
TACO
TACO:
- when does it occur?
- why does it occur?
- what are the symptoms?
- CXR findings?
TACO:
- when does it occur = ACUTE (within 6 hrs usually)
- why does it occur = due to lack of attention to fluid balance, esp. in CF, renal impairment, hypoalbuminaemia, + fluid balance
- what are the symptoms:
1) SOB
2) reduced O2 sat
3) high HR
4) high BP - CXR findings:
1) fluid overload
2) Cardiac Failure
TRALI:
- when does it occur?
- what are the symptoms?
- CXR findings?
TRALI:
- when does it occur = ACUTE (during or within 6 hrs usually)
- what are the symptoms:
1) SOB
2) reduced O2 sat
3) high HR
4) high BP
**same as TACO) - CXR findings:
1) bilateral pulmonary infiltrates not due to circulatory overload
pathophysiology of TRALI
why does it occur = anti-WBC abs in donor => interact with patient WBCs => aggregates => stuck in pulmonary capillaries => lung damage
**sometimes abs not implicated
Which infections cause (delayed) associated with transfusion reaction
- Malaria
- HIV 1/2, HEV, HBV, HCV, HLV 1/2, Parvovirus, CMV, WNV, Zika
- Variant CJD
Pathophysiology of delayed haemolytic transfusion reaction
1-3% of all patients transfused develop an “immune” antibody to an RBC antigen they lack = ALLOMMUNISATION
if patient receives another transfusion with RBCS expressing the same antigens => abs cause RBC destruction = EXTRAVASCULAR HAEMOLYSIS (as IgG) so takes 5-10 days
What investigation findings will suggest delayed haemolytic transfusion reaction?
haemolysis screen:
- raised:
1) bilirubin
2) LDH
3) retics - reduced:
1) Hb - DAT +
- Haemoglobinuria (over few days)
- U&Es - if renal failure
- repeat G&S - for new abs
Transfusion associated Graft-V-Host Disease (TaGVHD):
- when does it occur?
- what are the symptoms?
- prognosis?
Transfusion associated Graft-V-Host Disease (TaGVHD):
- when does it occur = usually 7-10 days post transfusion
- what are the symptoms:
1) severe diarrhoea
2) liver failure
3) skin desquamation
4) BM failure - prognosis?
rare, but always fatal (death weeks to months post transfusion)
Pathophysiology of Transfusion associated Graft-V-Host Disease (TaGVHD)
Normally => donor’s blood contains lymphocytes => patient immune system recognises donor’s lymphocytes as foreign and destroys them
TaGVHD => susceptible patient (very immunosuppressed) = lymphocytes not destroyed => lymphocytes recognise patient tissue HLA ags as foreign => attack patient’s gut, liver, skin, BM
How to prevent TaGVHD?
Irradiate blood components for very immunosuppressed or give HLA-matched components
