ADVERSE EFFECTS OF BLOOD TRANSFUSION

Question 1

The recognition and evaluation of suspected transfusion
reactions involves two critical components:

Answer 1

-Clinical recognition by the person administering the
transfusion
-Laboratory investigation of a transfusion reaction

Question 2

AABB Requirements for Laboratory Investigation of a Transfusion Reaction

Answer 2

1. Clerical check of the component bag, label, paperwork, and pretransfusion patient specimen.
2. Repeat ABO testing on the post-transfusion sample.
3. Visual check of the pre- and post-transfusion specimens for hemolysis.
4. Direct antiglobulin test (DAT) on the post-transfusion specimen.
5. Quarantine additional components prepared from the same donor collection.
6. Report findings to transfusion service supervisor or medical director.

Question 3

IMMEDIATE IMMUNE HEMOLYTIC TR

Answer 3

Immediate hemolytic TR
Febrile non hemolytic TR
ALLERGIC URTICARIAL TR
Anaphylactic Anaphylactoid
Transfusion Related acute lung injury

Question 4

Immediate non immune TR

Answer 4

Transfusion Transmitted Bacterial Contamination
Transfusion Associated Circulatory Overload

Question 5

Delayed Immune TR

Answer 5

Delayed Hemolytic TR
Post transfusion Purpura
Alloimmunization

Question 6

Delayed non Immune TR

Answer 6

Iron overload

Question 7

Acute hemolysis with accompanying presenting symptoms
within 24 hours of transfusion.
●Severe, rapid onset, fever, chills, flushing, pain at site
of infusion, tachycardia, hemoglobinemia,
hemoglobinuria
● DIC, Renal Failure, Irreversible Shock, Death
● Intravascular hemolysis

Answer 7

IMMEDIATE HEMOLYTIC TR

Question 8

IMMEDIATE HEMOLYTIC TR
ABO Incompatible blood are transfused 4 common Antibodies

Answer 8

-Anti-A (most common)
-Anti-Kell
-Anti-Jka
-Anti-Fya

Question 9

Laboratory Tests Confirming Hemolysis

Answer 9

• Decreased fibrinogen
• Decreased or absent haptoglobin
-Elevated bilirubin
-Elevated LDH
* Hemoglobinemia
-Hematuria or hemoglobinuria
* Spherocytes
* Inadequate rise of post-transfusion hemoglobin level or rapid fall of hemoglobin after transfusion

Question 10

Serologic Evidence of Immune Mediated Htr

Answer 10

Positive DAT for polyspecific and anti-IgG or anti-C3
Positive elution test with identification of one or more alloantibodies

Question 12

Positive DAT and gradual drop in patient’s hemoglobin
and hematocrit, mild jaundice

Answer 12

DELAYED HEMOLYTIC TR

Question 13

DELAYED HEMOLYTIC TR antibodies

Answer 13

Rh , kell, kidd, duffy , mns

Question 14

EXTRAVASCULAR HEMOLYSIS - PRIMARY
MECHANISM OF

Answer 14

DELAYED HEMOLYTIC TR

Question 15

Any 1°C temperature rise associated w/ transfusion and
having no medical explanation other than blood component transfusion. PYROGEN from transfused WBC , Self-limiting Fever will resolve within 2-3 hrs.

Answer 15

FEBRILE HEMOLYTIC TR

Question 16

FEBRILE HEMOLYTIC TR prevention

Answer 16

use LEUKOREDUCED blood components

Question 17

The donor plasma has a foreign protein (allergen) w/ which
antibodies is present in patient’s plasma causing it to react.
The donor plasma has reagin that react with the allergen
present on patient plasma.

Answer 17

ALLERGIC (URTICARIAL) TR

Question 18

ALLERGIC (URTICARIAL) TR prevention

Answer 18

Washed RBC

Question 19

Can range from mild urticaria and pruritus to severe
shock and death

Answer 19

ANAPHYLACTIC/ANAPHYLACTOID TR

Question 20

ANAPHYLACTIC/ANAPHYLACTOID TR 2 significant features:

Answer 20

A. fever is absent
B. clinical signs and symptoms occur after transfusion of
just few milliliters of plasma containing blood
components.

Question 21

Consists of an acute transfusion reaction presenting with
respiratory distress and severe hypoxemia during or within
6 hours of transfusion in the absence of other causes of acute lung injury.

Answer 21

TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI)

Question 22

Anti-leukocyte antibodies (anti-human neutrophil antigen
(HNA) and anti-HLA antibodies) in donor or patient plasma
could initiate complement-mediated pulmonary capillary
endothelial injury.

Answer 22

TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI)

Question 23

TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI) prevention

Answer 23

use LEUKOREDUCED blood components

Question 24

These reactions are the most common and account for over 90 % of
TR.

Answer 24

FNHTR

Question 25

A good example of iatrogenic transfusion reaction. The usual rate of transfusion is 200 ml/hr. Patients at significant risk: 1. Children 2. Elderly 3. Cardiac disease 4. Patient with chronic normovolemic anemia

Answer 25

TRANSFUSION ASSOCIATED CIRCULATORY OVERLOAD (TACO)

Question 26

TRANSFUSION ASSOCIATED CIRCULATORY OVERLOAD (TACO) prevention

Answer 26

use WASHED/FROZEN RBC

Question 27

-Also known as transfusion- associated sepsis -Clinically, this type of reaction is termed "warm" -Dryness and flushing in patient's skin -According to CDC, most common pathogen is Yersinia enterocolitica. Platelet units: gram-positive cocci and are from normal skin flora introduced into the product during venipuncture.

Answer 27

TRANSFUSION-TRANSMITTED BACTERIAL INFECTIONS (TTBI)

Question 28

Long term complication of RBC transfusion Known as "Hemosiderosis" Accumulated iron begins to affect the function of heart, liver and endocrine glands.

Answer 28

Iron overload

Question 29

Most common adverse reactions:

Answer 29

1. Allergic transfusion reactions and 2. Febrile nonhemolytic transfusion reactions

Question 30

Most common transfusion reactions associated with mortality:

Answer 30

1. Transfusion-related acute lung injury (TRALI) 2. Transfusion-associated circulatory overload (TACO)