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Year 3: Haematology > Blood Transfusion Reactions > Flashcards

Blood Transfusion Reactions Flashcards

1
Q

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

A
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2
Q

State 6 blood product transfusion complications [6]

A
  • Non-haemolytic febrile reaction
  • Minor allergic reaction
  • Anaphylaxis
  • Acute haemolytic reaction
  • Transfusion-associated circulatory overload (TACO)
  • Transfusion-related acute lung injury (TRALI)
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3
Q

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

A

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

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

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4
Q

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

A

acute haemolytic reaction or febrile non-haemolytic reaction

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5
Q

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

A

Typical with an allergic transfusion reaction.

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6
Q

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

A

Typical with an allergic transfusion reaction.

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7
Q

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

A
  • 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
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8
Q

Describe the pathophysiology of acute haemolytic reaction [4]

A

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

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9
Q

Describe the pathophysiology of allergic transfusion [2]

A

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

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10
Q

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

A

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

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11
Q

Blood transfusion reaction

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

A

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

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

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12
Q

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

A

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 !

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13
Q

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

A

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.

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14
Q

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

A
  • 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
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15
Q

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

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

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

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

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16
Q

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

A

Slow / stop transfusion

Give paracetamol (antipyretic) & monitor

17
Q

Describe the pathophysiology of TRALI [1]

A

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

18
Q
A
19
Q

Describe the pathophysiology of TACO [1]

How long does it occur after transfusion? [1]

A

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

20
Q

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]

A
  • 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
21
Q

How serious are

A
22
Q

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

A

Sickle cell disease

23
Q
A
24
Q

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

What are the clinical consequences of this? [1]

A

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

25
Q

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

A

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

26
Q

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

A

Hb < 70 if normal
Cardiac: Hb < 80

27
Q
A

Pruritis, urticaria

28
Q
A

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

29
Q
A

Pulmonary oedema, hypotension, fever

30
Q

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

A

IgM

31
Q

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)

A

Non-haemolytic febrile reaction

32
Q

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)

A

Acute haemolytic transfusion reaction

33
Q

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

A

Temporarily stop the transfusion, give antihistamine, monitor

34
Q

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

A

a non-haemolytic febrile reaction

35
Q

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

A

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

36
Q

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

A

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.

37
Q

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

A

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

38
Q

Irradiated blood products are used to which blood transfusion pathology? [1]

This specifically stops which cell type?

A

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

39
Q
A

Year 3: Haematology (23 decks)

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