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Immunohematology > Adverse Effects of Blood Transfusions > Flashcards

Adverse Effects of Blood Transfusions Flashcards

(52 cards)

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1
Q

Errors Associated with Transfusions

A

Patient Misidentification (very common)
Sample Error
Wrong Blood Issued
Transcription Error
Blood Administration Error
Technical Error
Blood Storage Error

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2
Q

Types of Transfusion Reactions

A

Non-hemolytic Reactions
Hemolytic Reactions
- Immediate Intravascular or Extravascular
- Delayed Extravascular

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3
Q

Types of Non-hemolytic Reactions

A

96% of all reactions are non-hemolytic
Febrile
Allergic
Anaphylactic
Circulatory Overload (TACO)
Transfusion Related Acute Lung Injury (TRALI)
Graft vs Host
Transfusion Transmitted Disease

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4
Q

Febrile Reaction

A

Occurs in 1% of transfusions
>1 degree C rise in temperature
Caused by anti-WBC Antibodies

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5
Q

Febrile Symptoms

A

Fever
Chills

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6
Q

Febrile Future

A

Use leukocyte poor products

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7
Q

Allergic Reaction (Type 1)

A

Implicated in 20% of all reactions
Reaction to donor plasma

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8
Q

Allergic Symptoms

A

Itching
Hives
Edema

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9
Q

Allergic Future

A

Use plasma free products
Wash cells prior to giving

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10
Q

Anaphylactic

A

Caused by Allo Anti IgA Antibody

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11
Q

Anaphylactic Symptoms

A

Mild Allergic reaction
Shock
Death

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12
Q

Anaphylactic Future

A

Plasma free products
Donors lacking IgA (request specific from Blood Bank)

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13
Q

Circulatory Overload

A

Transfusion Associated Circulatory Overload (TACO)

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14
Q

Circulatory Overload Symptoms

A

Chest Pain
Dyspnea
Cough
Heart Failure

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15
Q

Circulatory Overload Future

A

Infuse more slowly (increase time 2 to 4 hours)

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16
Q

Transfusion Related Acute Lung Injury

A

Anti WBC Antibodies - cross react with lungs
Damage to Lung Tissue

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17
Q

Transfusion Related Acute Lung Injury Symptoms

A

Chills
Cough
Fever
Respiratory Failure (most significant indicator)

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18
Q

Graft vs Host

A

Significant mortality
3 - 30 days after transfusion
Donor T cells attack immunocompromised patient

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19
Q

Graft vs Host Symptoms

A

Pancytopenia - decrease in all cell lines
Fever
Abnormal Liver function

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20
Q

Graft vs Host Future

A

Irradiated products

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21
Q

Transfusion Transmitted Disease

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A

Hepatitis
HIV
HTLV
West Nile
CMV and EB
Malaria
Babesiosis
Chaga’s Disease
Toxoplasmosis
Rocky Mountain Spotted Fever
Syphilis

22
Q

Transfusion Induced Hemosiderosis

Study These Flashcards
A

Iron Overload

23
Q

Post Transfusion Purpura (PTP)

Study These Flashcards
A

Platelet Alloantibodies
Depletion of platelets and Coag factors

24
Q

Post Transfusion Purpura Symptoms

Study These Flashcards
A

Tiny red Pin Points on patient skin

25
Complications Associated with Massive Transfusion
Citrate Toxicity - due to level of citrate in units Hypothermia Dilutional Thrombocytopenia
26
Hemolytic Transfusion Reactions
Up to 4% of all transfusion reactions Defined by Intravascular vs Extrascular and Immediate vs Delayed
27
Immediate Intravascular Hemolysis
Caused by IgM - complement Activating Ab IgG - Cause immediate hemolysis ABO Mix-up
28
Immediate Intravascular Hemolysis Symptoms
Occurs within minutes to 2 hours Fever or Chills Renal Shutdown DIC Hemoglobinemia
29
Immediate Intravascular Hemolysis Mortality
10%
30
Immediate Intravascular Hemolysis Treatment
Support (treat fever/chills) Stop transfusion
31
Immediate Extravascular Hemolysis
Same as Immediate Intravascular Hemolysis
32
Immediate Extravascular Hemolysis Symptoms
Fever, Chills Renal Shutdown DIC
33
Delayed Extravascular Hemolysis
Anamnestic Response or Ab Production (creation of new Ab or titer increase) 1-3 days
34
Delayed Extravascular Hemolysis Antibody Specificity
Rh Antibodies Anti-Jka (most often seen) Anti-K Anti-Fya
35
Delayed Extravascular Hemolysis Symptoms
3-7 days post transfusion Hgb and Hct decreased Mild symptoms - Fever - Chills - Jaundice - Lack of Energy
36
Delayed Extravascular Hemolysis Treatment
Support Give new cells that are antigen negative for new Ab
37
Physical Damage to Transfused Cells
Heat Damage Physical Damage
38
Heat Damage
Blood Warmers Storage
39
Physical Damage
Pumps Heart Valves ECMO
40
Microbe Contamination Common Organisms
Yersinia enterocolitica Pseudomonas E. coli
41
Microbe Contamination Symptoms
Rapid Onset Fever Chills DIC Shock Death (septicemia)
42
Microbe Contamination Treatment
IV Antibiotics Support
43
Microbe Contamination Prevention
Visual Inspection of Units
44
Patient Care Personnel Responsibilities
Take Vital Signs Stop Transfusion Keep IV Line Open with Saline Notify Physician and transfusion service Perform bedside clerical check DOCUMENT information Treat patient with antihistamines
45
Laboratory Personnel Responsibilities
Perform Clerical Check Observe pre & post samples for visual hemolysis Serum/plasma hemoglobin Gram stain/culture Perform DAT on post sample (perform on pre if post is pos) DAT pos: Elution and identify Ab DAT neg: Elution and identify Ab (may need to concentration Ab)
46
Proceed to Extended Evaluation IF
Discrepancy in Clerical Check Post DAT pos AND pre DAT neg or weaker AND no ABO incompatible units transfused Visual hemolysis Post Serum/plasma hemoglobin 20 mg/dl greater than Pre Serum/plasma hemoglobin
47
Extended Evaluation (Perform on Pre and Post Patient Sample)
Perform ABO/Rh IAT - identify Ab if applicable Crossmatch again
48
Extended Evaluation (Perform on Lab Seg from Donor)
ABO/Rh Ag Type if Ab Identified
49
Extended Evaluation (Additional Testing)
Urine Hemoglobin - Microscopic if Hgb is positive Serum Bilirubin - Collect 3-6 hrs post transfusion Plasma Hemoglobin (increased post vs pre) Haptoglobin (decreased post vs pre) Cultures - rule out septicemia
50
Transfusion Reaction Documentation
CRITICAL PART OF INVESTIGATION
51
Transfusion Reaction Documents
Notification of physician and blood bank director Reporting of reactions to accrediting agencies Fatalities - FDA, Center for Biologic Evaluation & Research
52
Notification of Pathologist
Discrepant Clerical Check Positive DAT in post-reaction with pre-reaction DAT negative No record of transfusion of ABO incompatible plasma Visually-evident hemolysis confirmed by 2 samples Serum/Plasma hemoglobin 20 mg/dl higher than pre-sample Positive Gram stain/culture

Immunohematology (17 decks)

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