transfusion reactions Flashcards by Kirsten Sacli

what causes an immediate hemolytic transfusion rxn?

ABO incompatible units
complement binding to C9 = intravascular hemolysis

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how long until an immediate hemolytic reaction and what are the symptoms

immediate 1-15 mins with fevers, chills, chest pain, and hemoglobinuria
progression: low BP, shortness of breath, nausea, burning along the vein, angioedema, back pain, anxiety, DIC, death

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what is the treatment of an immediate hemolytic

supportive care

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what are other rare non ABO causes of an immediate hemolytic reaction

pre formed antibody in the recipient
no antibody screen or antibody is too low frequency antigen (Cw, V, Kpa)
RBC unit is antigen positive (Kidd, Kell, Rh antibodies)

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how can we prevent an immediate hemolytic reaction?

CLERICAL CHECKS, ensure every product leaving the lab is AB compatible

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what is the cause of a febrile non hemolytic reaction?

soluble vasoactive cytokines in the product (often plt) from WBC breakdown
HLA antibodies in patient that react with donor wbc

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symptoms of a febrile non hemolytic

fever with or without chills

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treatment of a febrile non hemolytic reaction

acetaminophen, rule out other fever causing reactions
universal pre-storage leukoreduction has helped reduce febrile reductions

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what is the cause of a mild allergic (urticarial) reaction

mild allergic results from IgE antibodies in patient reacting with an allergen in the donor plasma (food, protein, preservative)

antibodies bind mast cells which release granular contents (histamine) to give symptoms of urticarial (hives) and pruritis (itching)

have mild cardiac symptoms but BP is stable

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timing of a mild allergic reaction

1-45 mins start of transfusion

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treatment of mild allergic reaction

antihistamines - can transfuse slowly

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cause of a severe anaphylactic reaction

due to donor IgA antibodies (it is the antigen)
recipient is IgA deficient and makes anti-IgA from previous transfusions
Anti-Iga- IgA interactions leads to severe anaphylaxis
can be allergen in donor plasma but is rare (like peanuts)
IgE Mast cells degranulation

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timing of a sever anaphylactic reaction

within minutes of infusion (1-15 mins) can start mild allergic and progress

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symptoms of sever anaphylactic

urticaria, pruritis, SOB, dyspnea, low BP, hypoxemia, GI
smooth muscle contraction - GI, trachea, bronchi, bronchioles
vasodilation - drop in blood pressure

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treatment of severe anaphylactic

epinephrine, antihistamines, corticosteroids, supportive therapy

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prevention of a severe anaphylactic reaction

request IgA deficient products
1/1000 people are IgA deficient
wash rbc/plt units
transfuse with caution

cause of a bacteriogenic reaction

bacteria in blood product from
- normal skin flora from donor arm
- transient bacteremia in donor
- contamination of product during processing/ product manipulation
- improper storage temperature

time of bacteriogenic reaction

minute - hours of toxins are present / high bacterial load in the bag several days if low microbial count - depends on patient’s immune status

storage of blood products that can cause a bacteriogenic reaction

platelets that are store at 20-24 degrees
red cells that can grow psychrophiles (0-25): e coli, pseudomonas, yersinia enterocolitica

symptoms of a bacteriogenic reaction

fever, chills, rigors, hypotension, flushing, clammy skin, tachycardia, DIC

treatment of a bacteriogenic reaction

broad spectrum antibiotics (do blood cultures aerobic and anaerobic)
culture the donor products/ empty bag if available

what is the cause of a delayed hemolytic reaction

antibody formation to non ABO antigens in donor blood (Rh, Kell, Kidd, Duffy, Ss)
antibodies bind donor cells and are removed by the liver and spleen (extravascular hemolysis)

timing of a delayed hemolytic trxn

2-14 days post transfusion, usually due to secondary exposure

products of a DH trxn

red blood cells

symptoms of a DH trxn

fevers, chills, malaise, jaundice or no symptoms

what is the treatment of a DH trxn

none! monitor Hb, bilirubin, lactate dehydrogenase, and haptoglobin

what are the hematological tests we can test

hemoglobin should be increased if transfused properly hemoglobin is either decreased or increased increased bilirubin means increase hemolysis increased lactate dehydrogenase decreased haptoglobin

why is a positive DAT important post transfusion

a positive DAT is significant in a delayed hemolytic reaction

what are some other rare causes of a pos DAT post transfusion

- transfusion of a passive antibody - transfusion if IVIg that binds non specifically to rbs - donor is DAT pos

significance of the immune response curve

IgG antibody concentrations will increase after the secondary exposure and will bind to donor cells

indicators of IVH

- visible hemolysis present - hemoglobinuria - decreased haptoglobin - increased LD

indicators of EVH

- increased bilirubin - increased LD - decreased haptoglobin - decreased hemoglobin ( or Hb that fails to increase)

transfusion reaction investigation procedure:

- clerical check (bedside, in lab - pretransfusion req, specimen, donor bag) - review symptoms - note product transfused - time of transfusion to symtoms - volume transfused - check for visible hemolysis on post transfusion sample - perform serological testing - ABO Rh, antibody screen, DAT, XM - perform non serological testing - Hem or CHem

a patient gets transfused and had an Abscr that was neg and XM that was neg, the post transfusion sample however has a neg Abscr, pos DAT, and a neg XM. what happened?

not enough antibody came up causing a neg Abscr - happens closer to the beginning eg. if anti-c present in the plasma -> will bind to donor cells in which less Ab left in plasma will be detected

when doing a transfusion reaction these are the results of a screen, DAT and XM. what happened? Abscr: pos DAT: neg XM: pos

starting the reaction all donor cells tagged are removed. collection of this sample was done at a later time

what is the delayed transfusion workup

- Ab ID if screen is positive -perform elution on DAT pos cells - Ag type implicated donor segments - do not Ag type patient if the have been transfused in the past 3 months - update records - serologically crossmatch with implicated donor units (should be pos) - serologically crossmatch Ag neg donor for subsequent transfusions if XM is still valid (within 96 hours)

what testing is done on these samples in a transfusion reaction: pretransfusion sample posttransfusion sample donor segment

pre: clerical check, ABO Rh, Ab screen, serological crossmatch post: clerical check, check hemolysis, ABO Rh, Ab screen, DAT, serological XM donor: clerical check, ABO Rh, antigen type for Ab detected in pre or post sample