Week 7 Flashcards
What is haemovigilence?
A set of surveillance procedures covering the whole transfusion chain (from the collection of blood and its components to the follow-up of recipients),
intended to collect and assess information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products, and to prevent their occurrence or recurrence …
Who is responsible for haemovigilance in Australia under the governance of the Haemovigilance Advisory Committee?
The NBA
What is the rationale for setting up a national haemovigilance program?
to enable transfusion practice and product improvements
What are the 3 most commonly transfusion reactions reported in Australia?
FNHTR, Allergic, TACO
List 5 Transfusion risks and factors contributing to adverse events.
- Individual patient characteristics
- Blood component
- Equipment
- Concomitant medication & IV fluids
- Procedures
Febrile, allergic and anaphylactic reactions occur more commonly in
multiparous women and in patients with IgA deficiency and anti-IgA antibodies.
What types of transfusions are associated with the highest rates of febrile non-haemolytic transfusion reactions?
Platelets and granulocytes
What type of contamination are platelets at a higher risk for? Higher than RBC
Bacteria
Transfusion of fresh frozen plasma is associated with a higher risk of what type of reaction?
allergic
Some reactions are mild, but severe life-threatening reactions such as anaphylaxis and
Transfusion- related acute lung injury (TRALI) may occur.
What are 2 examples of potential adverse effects due to inappropriate equipment?
▪ Heat damage to red cells due to an un-calibrated or poorly maintained blood warmer (ie, red cells should not be taken above 40 ºC)(2)
▪ Mechanical damage to red cells through use of an inappropriate infusion pump
Can medication or solutions be added to or infused through the same tubing with blood or components
no except 0.9% Sodium Chloride, Injection
BP
Why must Crystalloid and colloid solutions containing calcium (eg, Haemaccel) must never be added to or administered through the same intravenous line as blood or component collected in an anticoagulant containing citrate
because they interfere with the anticoagulant effect, resulting in clotting
What are the majority of procedures errors a the result of?
failure to follow procedures, or inadequate or unclear procedures.
How do we classify transfusion-related Adverse Reaction and Estimated Incidence?
Acute: Immuological Acute; Non-immunological Acute
Delayed: Immunological Delayed; Non-Immunological Delayed
What is the timeframe for it to be considered ACUTE and delayed?
less than 24hours - know that this is antibody related
What are the common adverse reactions?
Fever, rash, dyspnoea
List 2 examples of Immunological acute
FNHTR, Fatal acute haemolytic reaction
List 2 examples of non-immunological acute
complications of massive transfusion. TACO
List 2 examples of immunological delayed
Post transfusion purpura
Alloimmunisation - RBC antigens
List 2 examples of non immunological delayed
Iron overload with organ dysfunction
Transfusion-transmissible infections
What are the Steps for managing suspected transfusion reactions?
- Stop the transfusion immediately
- Check and monitor vital signs
- Maintain intravenous (IV) access (Do not flush existing line and use a new IV line if required)
- Check the right pack has been given to the right patient
- Notify your Medical Officer and Transfusion Service Provider
What is the Most common tranfusion reaction accouting for 47.3% of adverse transfusion events in Aust and the cause and what would the DAT result be?
• Usually not life threatening
• Within 4 hr of transfusion
Febrile Non hemolytic Reactions (FNHTR)
cytokines released by WBC during blood product storage
DAT - neg
What is the second most common transfusion reaction?
Allergic and anaphylactic reactions. Allergic = hives Anaphylactic = rapid and severe
What is the third most common transfusion reaction?
Transfusion-Associated Circulatory Overload (TACO)
Patients at highest risk for TACO?
younger than three
• older than 60 years of age, particularly those with underlying cardiac dysfunction
Allergic or Urticurial reactions: What would the DAT result be and what is the cause?
DAT - neg
Cause - recipient Ab to foreign plasma proteins
Anaphylactic reactions: What would the DAT result be and what is the cause?
DAT - neg
Cause - recipient has IgA deficiency
What is the 4th most common blood transfusion reaction? and possible cause?
IBCT - incorrect blood component transfusion
cause - blood component was for someone else or they needed special blood and didn’t get it ie: CMV neg needed and CVM pos was transfused.
What are the 3 major areas for human error that jeopardise human error?
- accurate patient identification and proper labelling of pre-transfusion specimens
- appropriate decision-making regarding the clinical use of blood components
- accurate bedside verification that the correct blood is to be given to the intended
recipient.
If the blood has a transient bacteremia or there was
improper cleansing of the donor’s skin during collection what is a potential reaction that can happen to the recipient?
Transfusion Transmitted Infection (TTI)
Some organisms can grow upon storage
What transfusion reaction is triggered by the production or re-emergence of antibodies following transfusion and therefore are not generally detectable at the time of pre-transfusion compatibility testing.
DELAYED Haemolytic Transfusion Reaction (DHTR)
What lab results would you expect to see with
DELAYED Haemolytic Transfusion Reaction (DHTR)? What would the Ab screen be and what would the DAT be?
High bilirubin, high liver function tests (LDH), reticulocytosis, spherocytosis,
Antibody screen: positive
DAT: positive
What transfusion reaction is this describing? Rapid destruction of RBC (usually ABO can be fatal)
ACUTE Haemolytic Transfusion Reaction (AHTR)
What is the immune mechanism of ACUTE Haemolytic Transfusion Reaction (AHTR)?
RBC alloAb (recipient) + RBC Ag (donation) → haemolysis
What are the Ab and Ag factors that contribute to ACUTE Haemolytic Transfusion Reaction (AHTR)?
Ab: IgM or IgG → Titer / Concentration/ Specificity
Ag: Density, Distribution
Consequences of AHTRs
Hypotension
Irreversible Shock
Renal Failure
DIC
What are the risk strategies to minimise TRALI?
- deferring implicated blood donors
- suspending pooled platelets in platelet additive solution not plasma
- male-only plasma
What are the IMMUNE CAUSEs of TRALI?
Antibodies to HLA CII, HNA & HLA CI
→ Female donors were implicated
What should be done in suspected cases of transfusion-transmitted bacterial, viral or parasitic infections or transfusion-related acute lung injury (TRALI) ?
should be reported as soon as possible because immediate follow-up action may be required; for example, recalling potentially bacterially contaminated products prepared from the same donation or where further patient or donor investigations are necessary (e.g. suspected TRALI).
