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Hematology > Hematology Week 2: Adverse Transfusion Reactions > Flashcards

Hematology Week 2: Adverse Transfusion Reactions Flashcards

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1
Q

Question 1

A
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2
Q

Transfusion risks of bloode-borne infections

A
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3
Q

Prevalence of HIV and Hep C in the US?

A
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4
Q

Window Period

A

The period of time where the viral load is not high enough to be detected by a test

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5
Q

How long is HIVs Window period?

A

9-12 days

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6
Q

How long is Hep C Window period?

A

2 weeks

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7
Q

What is a transfusion reaction?

A
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8
Q

The frequency of transfusion reactions

A

most common Hives/urticaria

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9
Q

What to do for a suspected transfusion reaction?

A

STOP THE TRANSFUSION!

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10
Q

Acute Febrile Transfusion Reactions

3 listed

A

Acute Hemolytic Transfusion Reaction (AHTR)

Febrile Non-hemolytic Transfusion Reaction (FNHTR)

Bacterial Contamination (Septic Reaction)

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11
Q

AHTR AKA

A

Acute Hemolytic Transfusion Reaction

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12
Q

FNHTR AKA

A

Febrile Non-hemolytic Transfusion Reaction (FNHTR)

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13
Q

Septic Reaction AKA

A

Bacterial Contamination

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14
Q

Acute Febrile Reactions Qualifications

A

1*C rise over baseline or if chills/rigors are present

The fever can be something very benign (FNHTR)

or

something very serious

AHTR

Septic transfusion Reaction

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15
Q

When there is a suspected febrile transfusion reaction

3 listed

A

Clerical Check

  • Right blood to the right patient
  • Redo the patients ABO Rh type
  • Recheck crossmatch compatibility

Visual post-transfusion hemolysis check +/- hemolysis

DAT Test

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16
Q

DAT Test for a suspected febrile transfusion reaction

A
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17
Q

AHTR is most commonly caused by?

5 listed

A
  • Preformed antibodies that can activate complement and cause intravascular hemolysis of donor RBCs
  • Often due to ABO incompatible blood
  • Most often from blood administered to the wrong patient
  • Wrong identification of blood specimen
  • Crossmatch error
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18
Q

Classic S&S of AHTR

6 listed

A
  • Fever +/- chills (sometimes this is the only symptom!)
  • Unexplained microvascular bleeding/ DIC
  • Hypotension / shock
  • Gross hemoglobinuria
  • Renal Failure
  • Back/flank pain or pain at the infusion site
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19
Q

Testing for suspected intravascular hemolysis

5 listed

A
  • Positive DAT
  • Haptoglobin significantly decreased
  • LDH Increased
  • Indirect bilirubin increased
  • Urine Hemoglobin Positive
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20
Q

Septic Transfusion Reactions

A
  • Platelets are the highest frequency offender due to room temp storage from common skin flora contaminants (Gram + like staph/strep)
  • RBC transfusions - much rarer than platelet contamination; reactions are usually much more severe Gram - bacteria (yersinia enterocolitica, pseudomonas aeruginosa, serratia marcescens) MUCH MORE SEVERE
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21
Q

Platelets are stored at what temp

A

20-24 *C

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22
Q

Platelets storage needs and properties

A
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23
Q

How platelets are infected

A

Visually exam the unit!!! egg drop soup is no bueno!

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24
Q

Septic Transfusion Reactions Clinical Presentations

A

Fever - High often 2*C inrease

Rigors/chills

Hypotension (prominent)

Tachycardia

Nausea/vomiting

SOB

DIC

Symptoms typically occur very quickly within 15 minutes

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25
Lab features of a septic reaction 4 Listed
* Positive bacterial culture of bag and blood * negative DAT * Fever that does not respond to anti-pyretics * Lab evidence of DIC
26
FNHTR proposed mechanisms
Accumulated cytokines in product
27
FNHTR Clinical Presentations
* Fever (\>1\*C) during or soon after transfusion * +/- chills or sensation of feeling cold * Symptoms often appear towards the end of the transfusion
28
Case 1
E gram-positive bacteria such as staph
29
Case 1 part 2
D AHTR
30
Acute Dyspneic Transfusion Reactions 3 listed
* Transfusion-related acute lung injury (TRALI) * Transfusion associated circulatory overload (TACO) * Anaphylaxis
31
Allergic Transfusion Reactions 2 listed
**Mild Allergic**: Cutaneous Symptoms only **Anaphylactoid/anaphylactic**: hypotension, dyspnea, stridol, wheezing, GI symptoms, cardiocascular collapse
32
How to treat mild allergic transfusion reactions
25-50 mg IV diphenhydramine
33
Anaphylactic vs anaphylactoid
Anaphylactic has cardiovascular collapse
34
Anaphylaxis Clinical presentation
* Reactions usually occur 1-45 minutes of transfusion * similar to anaphylaxis from other causes * as little as a few mL of product can cause laryngeal edema and circulatory collapse * sever GI sumptoms (cramping, vomiting, diarrhea) * Treat like any other anaphylactic reaction
35
Anaphylaxis Symptoms 6 listed
* Skin findings * Angioedema * Bronchospasm/wheezing/SOB * GI symptoms * Hypotension * Cardiovascular collapse
36
Anaphylaxis Etiology
* Anti-IgA in IgA deficient patients * most commonly patient has preformed antibodies to donor serum proteins
37
Anti-IgA in IgA deficient patients important in
anaphylaxis transfusion reaction
38
TACO Mechanism
Caused by rapid and/or massive infusion of blood products that results in acute pulmonary edema (induced congestive heart failure)
39
TACO Presentation
Must occur within 6 hours of transfusion * **Dyspnea** * **Cough** * Tachycardia * **Hypertension** * crackles in lung bases * Elevated CVP/Pulmonary artery wedge pressure * severe headache
40
TACO vs TRALI
TACO has Hypertension
41
TACO high-risk patients
* Elderly and small patients * Liver/renal failure * Positive fluid balance * Severe compensated anemia
42
TRALI mechanism
* new acute lung injury that occurs within 6 hours of transfusion * of plasma-containing blood products are the most implicated * leading cause of transfusion-related mortality 6-10% mortality even if recognized
43
TRALI Presentation 6 listed
* Must occur within 6 hours of transfusion (most occur within 1 hr) * hypotension * Dyspnea/cyanosis * Frothy white fluid from the E.T. Tube * Bilateral "white out" on CXR * Mechanical ventilation needed to support oxygenation
44
TRALI etiology
* Donor anti-leukocyte antibodies bind recipient leukocytes * antibody/WBC complex localizes to the lungs * Leukocytes release cytokines and free oxygen radicals that damage the lung
45
Case 3
A TACO and treat with diuretics and oxygen support
46
Delayed Transfusion Reactions 3 listed
* Delayed hemolytic transfusion reaction (DHTR) * Post Transfusion Purpura (PTP) * Transfusion-associated graft-versus-host disease (TA-GVHD)
47
DHTR AKA
Delayed hemolytic transfusion reaction
48
PTP AKA
Post Transfusion Purpura
49
TA-GVHD AKA
Transfusion-associated graft versus host disease
50
DHTR Mechanism
Has a positive DAT against non-ABO antigens happens after 24 hours \<28days
51
DHTR Labs
reveal an inadequate rise in Hb or rapid fall in Hgb without other explanation Haptoglobin decreased LDH increased Indirect Bilirubin increased Transfusion Rx workup: donor blood is now crossmatch incompatible
52
DHTR Crossmatch
Donor blood is now crossmatch incompatible as their are new antibodies
53
DHTR Management
* symptomatic treatment (antipyretics) * renal failure can occur * protect kidneys * critical to acoid future transfusion with the implicated RBC antigen
54
PTP Mechanism
* alloantibodies directed against HPA-A1 antigen detected after development of thrombocytopenia * Post-transfusion there is a sudden decrease in platelets to less than 20% of pre-transfusion count * Occurs 5-12 days post-transfusion and patient has no other conditions to explain thrombocytopenia
55
PTP high risk patients
* women * prior sensitizing events such as pregnancy or transfusions
56
PTP Treatment 4 listed
* IVIG * +/- steroids * do not transfuse addition random donor platelets * if the clinical situation demands a platelet transfusion: use HPA-A1 platelets
57
TA-GVHD Mechanism
58
TA-GVHD Onset
4-30 days
59
TA-GVHD Symptoms 3 listed
* fever * rash * diarrhea
60
TA-GVHD Lab findings
pancytopenia liver function abnormalities
61
TA-GVHD Treatment
Bone Marrow transplant ready to go otherwise not much you can do
62
TA-GVHD Prevention
63
Acute Febrile Transfusion Reactions Diagnostic Clues
64
Acute Dyspneic Transfusion Reactions Diagnostic Clues
65
Take home points of Adverse Transfusion Reactions

Hematology (26 decks)

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