Lecture 4 - Adverse Reactions

Question 1

what does SHOT stand for?

Answer 1

serious hazards of transfusion

Question 2

what does SHOT do?

Answer 2

it is voluntary and anonymous and makes recommendations on how to improve patient safety

Question 3

what is SABRE?

Answer 3

serious adverse blood reactions and events

Question 4

what two companies merged together in 2017?

Answer 4

MHRA and SHOT, SABRE reports to both

Question 5

what reports does SHOT receive that are not reportable under BSQR?

Answer 5

solvent detergent fresh frozen plasma (octaplas) and anti-D immunoglobulin

Question 6

what is a SAR?

Answer 6

an unintended response in a donor or in a patient that is associated with the collection or transfusion of blood or components

Question 7

what reactions are associated with red cell antibodies?

Answer 7

acute haemolytic reaction and delayed haemolytic reaction

Question 8

what are the clinical symptoms of an allergic/anaphylactic reactions?

Answer 8

hypotension associated with a wheeze, swelling of face or limbs or mucus membranes, flushing

Question 9

how may an allergic reaction be caused?

Answer 9

if a patient has an allergy and the donor has consumed that allergen

Question 10

what type of component are allergic reactions usually associated with?

Answer 10

plasma rich components such as platelets or FFP

Question 11

what is an allergic reaction investigated for?

Answer 11

for an IgA deficiency

Question 12

what are the symptoms of febrile reactions?

Answer 12

fever, sometimes with shivering, muscle pain or nausea

Question 13

how are febrile reactions most commonly caused?

Answer 13

by antibodies directed against donor leucocytes and the HLA antigens or by pre-formed cytokines in the donor plasma

Question 14

how have febrile reactions been reduced?

Answer 14

due to leucodepleted blood components

Question 15

what cases makes febrile reactions more common?

Answer 15

more common in multi-transfused patients receiving red cells

Question 16

what is the treatment of a febrile reaction?

Answer 16

paracetamol and slow transfusion

Question 17

what is TA-GvHD

Answer 17

engrafted T lymphocytes from the transfused blood recognise the recipient as foreign and attack host tissues

Question 18

what makes TA-GvHD more likely to occur?

Answer 18

first degree relative donations due to HLA similarities and in immunocompromised patients

Question 19

how can TA-GvHD be prevented?

Answer 19

by irradiation

Question 20

what does TACO stand for?

Answer 20

tranfusion associated circulatory overload

Question 21

how can TACO be caused?

Answer 21

due to rapid transfusion of a large volume of blood

Question 22

what increases the risk of TACO?

Answer 22

over the age of 60, cardiac or pulmonary failure, renal impairment, hypoalbuminemia or anaemia

Question 23

what kind of patients are at an increased risk of TACO?

Answer 23

small patients such as elderly or children

Question 24

what is TRALI?

Answer 24

transfusion related acute lung injury

Question 25

how long does it take for TRALI to occur?

Answer 25

most cases present within 2 hours post transfusion with a max of 6 hours

Question 26

with are the signs of TRALI?

Answer 26

severe breathlessness and a cough associated with pink froth, hypotension and fever and rigors

Question 27

what kind of treatment is associated with TRALI?

Answer 27

supportive treatment, often in the ICU

Question 28

how might close link of TACO and TRALI cause mortality in someone with TRALI?

Answer 28

if confused with TACO, powerful diuretics may be given which can worsen TRALI

Question 29

what patients is white cell mediated TRALI common in?

Answer 29

females with previous pregnancies

Question 30

what type of products is WCM TRALI common in?

Answer 30

plasma products

Question 31

what is the mechanism for WCM TRALI?

Answer 31

the recipient must express the specific HLA or neutrophil receptors to which the donor blood has formed antibodies so the antibodies react with the neutrophils

Question 32

how does pulmonary oedema occur with TRALI?

Answer 32

activated neutrophils damage the endothelium which leads to vascular leakage into alveolar space

Question 33

what is cytokine mediated TRALI?

Answer 33

neutrophils accumulate in microvasculature and a soluble lipid accumulates which cause activation of neutrophils which then induce the release of cytokines which contributes to endothelial damage

Question 34

what effects does cytokine mediated TRALI have on the lungs?

Answer 34

cause vascular leaks and pulmonary oedema

Question 35

what are the differences between TACO and TRALI?

Answer 35

blood pressure is high in TACO yet low in TRALI, TACO improves with diuretics yet worsens TRALI

Question 36

what is TAD?

Answer 36

transfusion associated dyspnoea

Question 37

how is TAD characterised?

Answer 37

by respiratory distress within 24 hours of transfusion that does not meet the criteria of TACO or TRALI or an allergic reaction

Question 38

what does PTP stand for?

Answer 38

post transfusion purpura

Question 39

what is PTP?

Answer 39

unexpected thrombocytopenia 5-12 days post transfusion

Question 40

what type of patients does PTP usually effect?

Answer 40

Middle Aged or elderly women who have been alloimmunised against HPA-1a during pregnancy or previously transferred men

Question 41

what are the clinical features of PTP?

Answer 41

low platelet count, haemorrhage or widespread purpura and bleeding

Question 42

what is the treatment of PTP?

Answer 42

high dose IV IgG

Question 43

how has the incidence of TTI been reduced?

Answer 43

new generations of microbiological testing, diversion of first 20mls of blood

Question 44

what is the most common TTI?

Answer 44

hepatitis B

Question 45

what does ADU stand for?

Answer 45

avoidable or delayed or under transfused adverse event

Question 46

what is an ADU?

Answer 46

where a transfusion of a blood component was clinically indicated by not undertaken or availability led to a delay

Question 47

what is WCT?

Answer 47

wrong component transfused, patient transfused with component from incorrect blood group

Question 48

what is SRNM?

Answer 48

special requirements not met, where a patient transfused with a component that did not meet specific requirements such as irradiated, HLA matched, antigen negative red cells

Question 49

what is HSE?

Answer 49

handling and storage errors, component may be rendered unsafe after handling and storage

Question 50

what effect does low temperatures have on blood components?

Answer 50

haemolysis in red cell units, activation of platelets, precipitation of coagulation factors

Question 51

what effect does high temperatures have on blood components?

Answer 51

microbial infection, denaturing of coagulation factors