Transfusion Reactions

Question 1

How to manage suspected transfusion reactions

Answer 1

1. Stop blood product immediately
2. Monitor the patient
   *maintain IV line with NS
3. Save the blood bag
   *send back to blood bank
4. Send a new patient specimen to blood bank

Question 2

After the new patient specimen is sent to the blood bank what happens then

Answer 2

1. Bank will reaper ABO/RH and antibody screen, perform DAT, check clerical info
2. Back will visually inspect plasma for pink/red color
   *indicates hemolysis

Question 3

What happens if hemolysis is a concern

Answer 3

Pink plasma layer
1. Serum haptoglogin becomes undetectable
*a protein in blood that binds to Hgb
*destroyed RBC release Hgb into circulation
*haptoglobin is reduced since haptoglobin binds to the Hgb released from hemolysis

Question 4

What needs to happen if a patient is experiencing respiratory distress

Answer 4

1. Obtain CXR
   *TRALI is a non-cardiogenic pulmonary edema that occurs within 6 hr post transfusion

Question 5

What is acute intravascular hemolysis

Answer 5

1. ABO incompatible transfusion
   *can result in renal failure or death
2. Medical emergency
   *fever/chills, flank pain, sense of impending doom
   *hypotension, hemoglobinuria, renal failure

Question 6

How does some present with a non hemolytic febrile reaction

Answer 6

1. Usually mild, fever, chills, rigors, mild dyspnea
2. Is a reaction to donor WBC
3. More common in patients who have received multiple transfusion or delivered several children

Question 7

What happens during a mild allergic reaction to the blood

Answer 7

1. Urticaria
2. Pruritus can be caused y sensitization to plasma proteins in transfusion product

Question 8

What happens during a anaphylactic reaction

Answer 8

1. Acute hypotension, hives, abdominal pain and respiratory distress
2. Seen mostly in IgA deficient recipients

Question 9

What happens during sepsis

Answer 9

1. Transfusion of a bacterial infected transfusion product, with platelet transfusion having the greatest risk
   *staph epidermidis
   *pseudomonas
   *serratia
   *yersinia

Question 10

What happens during a transfusion associated acute Lung injury (TRALI)

Answer 10

Number one cause of transfusion related mortality
1. Fever, chills, hypotension, ARDS
2. Donor HLS antibodies attack recipients lund s
3. Bilateral whiteout seen on CXR
4. Hypoxemia O2 sat <90% on room air

Question 11

What is transfusion associated circulatory overload (TACO)

Answer 11

1. Usually due to excess volume infusion can exacerbate CHF
2. Acute dyspnea, rales within 6 hrs