Haem 13+14 - Blood transfusion

Question 1

What is the time frame for the different blood transfusion reactions?

Answer 1

Minutes:
Anaphylaxis (5-10m)

First few hours:

• Febrile non-haemolytic transfusion reaction
• Bacterial contamination (generally seen in plt transfusion due to high temp of storage)
• Acute haemolytic transfusion reaction - ABO incompatability / Rhesus

Later but <24h:

• Transfusion related acute lung injury (TRALI)
• Transfusion associated circulatory overload (TACO)

Days after:

• Graft v Host disease (GvHD)
• Delayed haemolytic transfusion reaction

Question 2

What are the different acute blood transfusion reactions?

Answer 2

Anaphylaxis

ABO incompatability
Bacterial contamination
Febrile-nonhaemolytic transfusion reaction

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

Question 3

Features of anaphylactic blood transfusion reaction? who is at greatest risk?

Answer 3

Anaphylaxis related symptoms occurring within minutes after transfusion

Risk increases in patients with IgA deficiency (IMPORTANT)due to presence of IgA in the transfusion

Question 4

Features of ABO incompatability transfusion reaction? what is the mechanism?

Answer 4

Occurs within minutes - hours after transfusion

The presentation can include pyrexia, abdominal/flank pain, blood in the urine, and shortness of breath

Causes IgM-mediated intravascular haemolysis

Question 5

Features of bacterial contamination transfusion reaction?

Answer 5

Symptoms occur within minutes to hours

More commonly occurs with platelet transfusion due to higher temp that it is stored at

Question 6

What are the features of febrile non-haemolytic transfusion reaction?

Answer 6

Rise in temperature of ≤1ºC without circulatory collapse

Caused by release of cytokines by leukocytes and prevented by leukodepletion

Question 7

What are the features of TACO? Increased risk?

Answer 7

Symptoms of pulmonary oedema/fluid overload occur within hours (bilateral interstital shadowing on CXR)

Look for signs of heart failure: ↑JVP, ↑PCWP,↑BP

May occur in pts w/ cardiac failure, renal impairment or v old

THIS RESPONDS TO FURESOMIDE UNLIKE TRALI

Question 8

What are the features of TRALI? mechanism?

Answer 8

Symptoms similar to TACO

Caused by interaction with anti-HLA antibodies in donor blood with recipient

Occurs < 6 hours

Absence of heart failure (IMPORTANT)

Question 9

What are some examples of delayed transfusion reactions? +what timeframe?

Answer 9

Delayed = >24hrs

Delayed haemolytic transfusion reactions
Graft v host disease

Question 10

What are the features of delayed hameolytic transfusion reaction? when to consider this?

Answer 10

Occurs within 1 week

Extravascular haemolysis – IgG-mediated

Consider these reactions when pt presents w/ haemolysis / anaemia day after transfusion

Question 11

What are the features of graft v host disease? prevention?

Answer 11

As name suggests - graft is fighting the host

Donor lymphocytes recognise recipient’s HLA as foreign and attack gut, liver, skin and bone marrow

Symptoms include diarrhoea, liver failure, skin desquamation and bone marrow failure

Prevent by irradiating blood components for immunosuppressed recipients

Question 12

What is the mx for warfarin reversal?

Answer 12

INR ≤5 – lower or omit next dose

INR 5-9 – either omit next dose or oral vitamin K

INR >9 – omit next dose + oral vitamin K

Any bleeding – omit next dose + IV vitamin K + PCC or FFP

Question 13

Differences between TACO and TRALI as causes of acute transfusion reactions?

Answer 13

JVP will NOT be raised in TRALI

The patient will NOT respond to furosemide in TRALI

Question 14

A 15-year-old boy with BetaThalassemia Major undergoes a bloods transfusion. Shortly after the blood transfusion is started, he feels feverish and has the chill​. His observation prior to the transfusion were taken. HR 82, BP 118/80, RR 16, Temp 36.7 and O2 97 (RA).

His observation were taken as soon as he complained of the symptoms HR 84, BP 114/78, RR 17, Temp 37.6, O2 97 (RA).

What is the likely cause of his symptoms?

AcuteHaemolysis
Transfusion related acute lung injury
Transfusion associated circulatory overload
Non –hemolytictransfusion reaction
Anaphylaxis

Answer 14

(Febrile) Non–hemolytictransfusion reaction

Small rise in temperature compared to before transfusion

HR and BP barely changed which occurs in non-haemolytic transfusion reaction

Question 15

A 40-year-old man who was involved in a major trauma is receiving a blood transfusion in hospital. Within 10 minutes of starting the transfusion, he becomes acutely unwell, with fevers, rigos and significant abdominal pain

Observations:HR 124bpm, BP 94/62 mmHg, O2 Sats 96% on air, RR 24/min, Temp 38.6ºC

What is the likely diagnosis?

Answer 15

Acute intravascular haemolytic transfusion reaction - V quick after start of infusion + ABDO pain + low BP and high HR (likely caused by ABO incompatability or Rhesus)

Question 16

A 63-year-old man is an inpatient on a gastroenterology ward after being admitted for an upper gastrointestinal bleed secondary to oesophageal varices. Hehas become short of breath over the last 20 minutes. HR 90 beats /min, RR 32 /min, BP 85/56 mmHg, O2 Saturations 92% on air, temperature 39.7ºC.

On examination he has bilateral inspiratorycrepitations.Heart sounds are normal and JVP is not raised. No rash or swelling is noted. The patient had completed a blood transfusion of 1 unit of blood 2 hours ago.

What is the most likely transfusion reaction?

Acute Haemolysis
Transfusion related acute lung injury
Transfusion associated circulatory overload
Non – haemolytic transfusion reaction
Anaphylaxis

Answer 16

TRALI = JVP not raised

NB: this pt won’t respond to furesomide