Blood Transfusion Reactions

Question 1

State the blood groups and the antibodies they produce [8]

Answer 1

Question 2

State 6 blood product transfusion complications [6]

Answer 2

• Non-haemolytic febrile reaction
• Minor allergic reaction
• Anaphylaxis
• Acute haemolytic reaction
• Transfusion-associated circulatory overload (TACO)
• Transfusion-related acute lung injury (TRALI)

Question 3

What are the symptoms [5] and signs [6] of acute haemolytic reaction?

Answer 3

Symptoms:
- fevers & rigors
- chest pain
- loin pain
- pain at drip site
- uncontrolled bleeding

Signs:
- anxiety / feeling of doom
- tachycardia
- hypotension
- Shock
- renal failure
- haemoglobinuria

Question 4

Chills would specifically indicate which reaction types are occurring? [2]

Answer 4

acute haemolytic reaction or febrile non-haemolytic reaction

Question 5

Flushing is most typical with what type of reaction? [1]

Answer 5

Typical with an allergic transfusion reaction.

Question 6

Dysopnoea is most typical with what type of reaction? [1]

Answer 6

Typical with an allergic transfusion reaction.

Question 7

Describe the managment plan when someone is undergoing a blood transfusion reaction

Answer 7

• STOP transfusion
• IV fluids
• FBC; coag. screen
• Repeat blood group (pre & post samples)
• Return blood unit to blood bank
• Blood cultures (to rule out sepsis)
• Catheter & monitor urine outpute (to prevent AKI)
• Intensive care, manage DIC and potentially give dialysis

Question 8

Describe the pathophysiology of acute haemolytic reaction [4]

Answer 8

Acute haemolytic reaction:
- Results from ABO incompatibility
- Preformed antibodies to donor antigens results in complement activation
- Causes intravascular haemolysis & associated severe acute inflammatory cascade
- This can result in DIC, shock or acute renal failure

Question 9

Describe the pathophysiology of allergic transfusion [2]

Answer 9

Allergic transfusion:
- hypersensitivity reaction to allergen proteins in donor plasma
- most severe form causes IgE mediated anaphylaxis
- typically manifests as urticaria

Question 10

Allergic reactions in blood transfusions are more common in? [3]

Answer 10

In components with more platelets as thought to be caused by foreign plasma proteins
- Platelets
- Plasma
- FFP
- Cryoprecipitate

Question 11

Blood transfusion reaction

Describe how you would treat a:
- Minor allergic reaction [3]
- Anaphylaxis reaction [2]

Answer 11

Minor allergic reaction:
- Temporarily stop transfusion
- Antihistamine
- Montior

Anaphylaxis reaction
- Stop transfusion
- IM adrenaline
- ABC supprt (w/ oxygen & fluids)

Question 12

Describe what is meant by a transfusion associated graft versus host disease (Ta-GVHD) [4]

Answer 12

Patients who recieve a transfusion and already have impared / low lymphocyte levels as they are immunocomprimised

Residual lymphocytes from the donor can multiply in the recipient and attack the host tissue

Can cause liver, skin gut and bone marrow damage

Fatal if left untreated !

Question 13

Describe how an allergic transfusion occurs in IgA deficiency patients [1]

Answer 13

anaphylactic reaction (technically anaphylactoid, as it is not IgEmediated) can occur as a result of anti-IgA antibodies in the recipient interacting with donor IgA.

Question 14

Describe the pathophysiology of a non-haemolytic febrile reaction [2]

Answer 14

• Interaction between recipient antibodies directed against leukocytes
  present in the red-cell or platelet unit transfused.
• may also result from the transfusion of proinflammatory substances
  including cytokines, complement fragments, and lipid compounds that are contained in the
  transfused unit’s plasma supernatant

Question 15

When does a non-haemolytic febrile reaction occur in relation to the transfusion? [1]

How serious is this? [1]
What are the features? [1]

Answer 15

• Occurs during or soon after the transfusion
• Unpleasant but not life-threatening

Features:
- Fever
- +/- tachycardia
- +/- inflammatory symptoms (rigors / myalgia / breathlessness / naseau)

Question 16

How do you treat a febrile non-haemolytic transfusion reactions? [2]

Answer 16

Slow / stop transfusion

Give paracetamol (antipyretic) & monitor

Question 17

Describe the pathophysiology of TRALI [1]

Answer 17

Transfusion-related acute lung injury (TRALI):
- Anti-leucocyte antibodies in donor react with recipient WBCS
- Patients are usually ill, which primes their WBCS

Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood

Question 19

Describe the pathophysiology of TACO [1]

How long does it occur after transfusion? [1]

Answer 19

TACO
* Pulmonary oedema due to excessive rate of transfusion with pre-existing heart failure
* ~ 12hrs after

Question 20

Describe what is meant by a delayed haemolytic reaction [1]

How long after a transfusion does it occur? [1]

What are four features of this? [4]

Answer 20

• Antibodies directed agaisnt other red cell antigens (asides from ABO antigens)
• 7-10 days after transfusion
• Causes extravascular haemolysis:
  1. Falling Hb
  2. Jaundice
  3. Dark urine
  4. Fever

Question 21

How serious are

Question 22

delayed haemolytic reaction is more likely to occur in which population group? [1]

Answer 22

Sickle cell disease

Question 24

Bacterial sepsis via bacterial contamination occurs via transfusion of which types of products? [1]

What are the clinical consequences of this? [1]

Answer 24

Bacteria from donor’s skin (such as Staphylcoccus) becomes infected in blood.

Most commonly occurs in platelet transfusions because these need to be kept at room temp.

Causes shock, kidney failure and death

Question 25

Which viruses are screened for in blood transfusions? [7]

Answer 25

Hep B Hep C Hep E CMV HIV HTLV-1/2 Syphilis

Question 26

What Hb levels indicate a blood transfusion in a normal patient? [1] and a patient with cardiac issues? [1]

Answer 26

**Hb < 70** if normal Cardiac: **Hb < 80**

Question 27

Answer 27

**Pruritis, urticaria**

Question 28

Answer 28

Stop the transfusion, check ID of patient and name on blood product, send blood for direct coombs test, supportive care

Question 29

Answer 29

**Pulmonary oedema, hypotension, fever**

Question 30

Acute haemolytic transfusion reaction occurs due to a mismatch of blood group (ABO) causing massive intravascular haemolysis. This is usually the resut of red blood cell destruction by which type of antibodies IgE IgA IgG IgM IgD

Answer 30

**IgM**

Question 31

Which of the following occurs due to white blood cell HLA antibodies Non-haemolytic febrile reaction Allergic/anaphylaxis reaction Acute haemolytic transfusion reaction Transfusion-associated circulatory overload (TACO) Transfusion-related acute lung injury (TRALI)

Answer 31

**Non-haemolytic febrile reaction**

Question 32

Which of the following has complications that include disseminated intravascular coagulation, and renal failure Non-haemolytic febrile reaction Allergic/anaphylaxis reaction Acute haemolytic transfusion reaction Transfusion-associated circulatory overload (TACO) Transfusion-related acute lung injury (TRALI)

Answer 32

Acute haemolytic transfusion reaction

Question 33

What is the management of a minor allergic reaction during a blood product transfusion? [1]

Answer 33

**Temporarily stop the transfusion, give antihistamine, monitor**

Question 34

*Slow or stop the transfusion, paracetamol, monitor* is the treatment for which reaction type? [1]

Answer 34

a non-haemolytic febrile reaction

Question 35

What is the pathophysiology of anaphylaxis during a blood product transfusion? [1]

Answer 35

**Can be caused by patients with IgA deficiency who have anti-IgA antibodies**

Question 36

Describe what is meant by post-transfusion purpura (PTP) [2]

Answer 36

PTP is an adverse reaction to a blood transfusion or platelet transfusion that occurs when the **body produces alloantibodies** to the **introduced platelets’ antigens.** These alloantibodies **destroy** the **patient**’s **platelets** leading to **thrombocytopenia**. PTP usually presents 5–12 days after transfusion.

Question 37

The typical clinical features of **[]** include fever during blood transfusion with no associated haemolysis.

Answer 37

The typical clinical features of **Febrile non-haemolytic transfusion reaction (FNHTR)** include fever during blood transfusion with no associated haemolysis.

Question 38

Irradiated blood products are used to which blood transfusion pathology? [1] This specifically stops which cell type?

Answer 38

Irradiated blood products are used to avoid **transfusion-associated graft versus host disease** This reduces the risk of GvHD as it **depletes T-cells.**