Week 7

Question 1

What is haemovigilence?

Answer 1

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 …

Question 2

Who is responsible for haemovigilance in Australia under the governance of the Haemovigilance Advisory Committee?

Answer 2

The NBA

Question 3

What is the rationale for setting up a national haemovigilance program?

Answer 3

to enable transfusion practice and product improvements

Question 4

What are the 3 most commonly transfusion reactions reported in Australia?

Answer 4

FNHTR, Allergic, TACO

Question 5

List 5 Transfusion risks and factors contributing to adverse events.

Answer 5

1. Individual patient characteristics
2. Blood component
3. Equipment
4. Concomitant medication & IV fluids
5. Procedures

Question 6

Febrile, allergic and anaphylactic reactions occur more commonly in

Answer 6

multiparous women and in patients with IgA deficiency and anti-IgA antibodies.

Question 7

What types of transfusions are associated with the highest rates of febrile non-haemolytic transfusion reactions?

Answer 7

Platelets and granulocytes

Question 8

What type of contamination are platelets at a higher risk for? Higher than RBC

Answer 8

Bacteria

Question 9

Transfusion of fresh frozen plasma is associated with a higher risk of what type of reaction?

Answer 9

allergic
Some reactions are mild, but severe life-threatening reactions such as anaphylaxis and
Transfusion- related acute lung injury (TRALI) may occur.

Question 10

What are 2 examples of potential adverse effects due to inappropriate equipment?

Answer 10

▪ 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

Question 11

Can medication or solutions be added to or infused through the same tubing with blood or components

Answer 11

no except 0.9% Sodium Chloride, Injection

BP

Question 12

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

Answer 12

because they interfere with the anticoagulant effect, resulting in clotting

Question 13

What are the majority of procedures errors a the result of?

Answer 13

failure to follow procedures, or inadequate or unclear procedures.

Question 14

How do we classify transfusion-related Adverse Reaction and Estimated Incidence?

Answer 14

Acute: Immuological Acute; Non-immunological Acute
Delayed: Immunological Delayed; Non-Immunological Delayed

Question 15

What is the timeframe for it to be considered ACUTE and delayed?

Answer 15

less than 24hours - know that this is antibody related

Question 16

What are the common adverse reactions?

Answer 16

Fever, rash, dyspnoea

Question 17

List 2 examples of Immunological acute

Answer 17

FNHTR, Fatal acute haemolytic reaction

Question 18

List 2 examples of non-immunological acute

Answer 18

complications of massive transfusion. TACO

Question 19

List 2 examples of immunological delayed

Answer 19

Post transfusion purpura

Alloimmunisation - RBC antigens

Question 20

List 2 examples of non immunological delayed

Answer 20

Iron overload with organ dysfunction

Transfusion-transmissible infections

Question 21

What are the Steps for managing suspected transfusion reactions?

Answer 21

1. Stop the transfusion immediately
2. Check and monitor vital signs
3. Maintain intravenous (IV) access (Do not flush existing line and use a new IV line if required)
4. Check the right pack has been given to the right patient
5. Notify your Medical Officer and Transfusion Service Provider

Question 22

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

Answer 22

Febrile Non hemolytic Reactions (FNHTR)
cytokines released by WBC during blood product storage
DAT - neg

Question 23

What is the second most common transfusion reaction?

Answer 23

Allergic and anaphylactic reactions. Allergic = hives Anaphylactic = rapid and severe

Question 24

What is the third most common transfusion reaction?

Answer 24

Transfusion-Associated Circulatory Overload (TACO)

Question 25

Patients at highest risk for TACO?

Answer 25

younger than three

• older than 60 years of age, particularly those with underlying cardiac dysfunction

Question 26

Allergic or Urticurial reactions: What would the DAT result be and what is the cause?

Answer 26

DAT - neg

Cause - recipient Ab to foreign plasma proteins

Question 27

Anaphylactic reactions: What would the DAT result be and what is the cause?

Answer 27

DAT - neg

Cause - recipient has IgA deficiency

Question 28

What is the 4th most common blood transfusion reaction? and possible cause?

Answer 28

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.

Question 29

What are the 3 major areas for human error that jeopardise human error?

Answer 29

1. accurate patient identification and proper labelling of pre-transfusion specimens
2. appropriate decision-making regarding the clinical use of blood components
3. accurate bedside verification that the correct blood is to be given to the intended
   recipient.

Question 30

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?

Answer 30

Transfusion Transmitted Infection (TTI)

Some organisms can grow upon storage

Question 31

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.

Answer 31

DELAYED Haemolytic Transfusion Reaction (DHTR)

Question 32

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?

Answer 32

High bilirubin, high liver function tests (LDH), reticulocytosis, spherocytosis,
Antibody screen: positive
DAT: positive

Question 33

What transfusion reaction is this describing? Rapid destruction of RBC (usually ABO can be fatal)

Answer 33

ACUTE Haemolytic Transfusion Reaction (AHTR)

Question 34

What is the immune mechanism of ACUTE Haemolytic Transfusion Reaction (AHTR)?

Answer 34

RBC alloAb (recipient) + RBC Ag (donation) → haemolysis

Question 35

What are the Ab and Ag factors that contribute to ACUTE Haemolytic Transfusion Reaction (AHTR)?

Answer 35

Ab: IgM or IgG → Titer / Concentration/ Specificity
Ag: Density, Distribution

Question 36

Consequences of AHTRs

Answer 36

Hypotension
Irreversible Shock
Renal Failure
DIC

Question 37

What are the risk strategies to minimise TRALI?

Answer 37

• deferring implicated blood donors
• suspending pooled platelets in platelet additive solution not plasma
• male-only plasma

Question 38

What are the IMMUNE CAUSEs of TRALI?

Answer 38

Antibodies to HLA CII, HNA & HLA CI

→ Female donors were implicated

Question 39

What should be done in suspected cases of transfusion-transmitted bacterial, viral or parasitic infections or transfusion-related acute lung injury (TRALI) ?

Answer 39

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).