transfusion reactions Flashcards by LUIMER RAMOS

could
cause transfusion reaction)

bacteria

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Most cases there are reactions that would manifest as _____ as related to TRALI
and TACO

pulmonary edema

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(most common sign of AHTR)

Fever (>1C rise above 37

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Collection of information on the complications (donor related reactions and even transfusionassociated reaction) of transfusion and blood collection

HEMOVIGILANCE

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hemovigilance factors

◦ Collection of transfusion reaction
◦ Analysis of data
◦ Improvements in preventing reactions

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MAIN CAUSE OF AHTR

Severity is related to amount of incompatible blood transfused

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Nationwide and international effort to track adverse reactions and improve transfusion practice of
blood collection, blood transfusion, and even transfusion of stem cell tissues and organs in order
to prevent certain cases of transfusion reactions

hemovigilance

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what comes first hemologbinuria or hematuria in AHTR?

Hemoglobinuria
Hematuria

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Accelerated destruction of transfused RBCs

ACUTE HEMOLYTIC TRANSFUSION REACTION (AHTR)

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Antibody-mediated incompatibility it may be because of ABO or other blood group antibodies

ACUTE HEMOLYTIC TRANSFUSION REACTION (AHTR)

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AHTR: DAT positive because of intervension of

gG and C3b that will promote destruction of RBCs

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In AHTR acute kidney injury can be attributed to

DIC

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Generally mild and self limiting

FEBRILE NONHEMOLYTIC TRANSFUSION REACTION (FNHTR)

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poikilocyte seen in AHTR

spherocytes

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in AHTR this is sign is because of the release of Hgb

Acute kidney injury

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treatment in AHTR that decreases the tendecies for coagulopathy

Heparin Transfusion

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Risk factors/ considerations
* Develops mostly in patients unable to report symptoms (unconscious, young, mute)
* Unconscious patients (ICU, surgery)
* ABO-mismatched platelet transfusions (“O” units to other AB types)

AHTR

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Plasma and platelet transfusions – because of the high content of antibodies in these
units specially in type O units are transfused into A, B, or AB can lead to

AHTR

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treatement for AHTR that promotes blood flow in glomerulus in the kidneys in order to promote
the production of urine

Furosemide

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One of the most common adverse transfusion reaction

FEBRILE NONHEMOLYTIC TRANSFUSION REACTION (FNHTR)

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Mimics other transfusion reactions (TRALI, AHTR, TACO, TAS) thus it is hard to diagnose

FEBRILE NONHEMOLYTIC TRANSFUSION REACTION (FNHTR)

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Problem: leads to discontinuation, wastage of blood units and delay during subsequent
transfusion

FEBRILE NONHEMOLYTIC TRANSFUSION REACTION (FNHTR)

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FNHTR is often caused by

Recipient anti-WBC antibodies, triggering cytokine release

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blood units that gives high tendency for FNHTR

Blood units that are not leukoreduced

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Administer antipyretics (acetaminophen (paracetamol)) – bring down fever; either IV or oral

FNHTR

what reaction? Fever (>100.4F or 38C); change of at least 1.8F (1.0C) within 4 hours

FEBRILE NONHEMOLYTIC TRANSFUSION REACTION (FNHTR)

what reaction? Mild dyspnea or mild change breathing patterns

FEBRILE NONHEMOLYTIC TRANSFUSION REACTION (FNHTR)

Incidence s much higher in hematology/oncology patients

FEBRILE NONHEMOLYTIC TRANSFUSION REACTION (FNHTR)

Patients with Sickle Cell Disease Chronic transfusion

FNHTR

Antibodies against donor plasma protein

ATRs

if hemolysis is detected in any of test for FNHTR, is he suffering from FNHTR or not

NOT suffering from FNHTR if there is hemolysis in test

Symptoms start to manifest close to the end of transfusion; 5-10% do not appear 1-2 hours post transfusion (somewhat delayed state)

FNHTR

Anti-WBC antibody in FNHTR

Anti-human neutrophilic antigen antibody

in FNHTR we do not use this for treatment

antihistamines, aspirin – may cause allergic reaction Aspirin because there is no DIC symptoms

Most common among platelet and plasma transfusions (2% of case); can happen in RBC transfusion

ALLERGIC TRANSFUSION REACTIONS (ATRs)

– to avoid FNHTR what blood unit should be used?

leukocyte-reduced units

ATRS: ▪ Mild to moderate ▪ Symptoms limited to skin and GI tract

allergic

ATRs: ▪ Moderately severe ▪ Involves mouth, throat – blockage of the airways – hard time breathing ▪ More serious GI tract symptoms, respiratory complaints

Anaphylactoid

ATRs: ▪ Severe, life threatening; may lead to CPR administration because of lose of consciousness ▪ Profound hypotension, shock

Anapylactic

IgA deficiency with anti-IgA – often react with IgA transfused of the donor that would lead to allergic anaphylactic reaction

ATRs

What reaction associated with this ◦ Haptoglobins ◦ Complement (C4) ◦ Cytokines

ATRs

ATR Mild reactions (cutaneous) treated by Mild reactions (cutaneous) treated by

diphenhydramine or antihistamines

ATRs: Severe urticarial, oropharyngeal or URT symptoms require what treatment

steroid treatment or epinephrine

ATR: Oxygen and blood pressure regulation may be necessary for anaphylactoid and anaphylactic reactions; nausea treatment?

Trendelenburg position

in ATR the use of IgA-deficient units is often seen in ?

washed RBC units

Leading cause of mortality of most blood transfusion ; adverse reactions to transfusion

TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI)

Aggravated by the amount of plasma transfused

TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI)

Main cause of TRALI:

presence of anti-WBC particularly donor anti-HNA and anti-HLA antibodies

Cytokines would activate endothelial cells to open or widen in order to neutrophils to pass through the alveolar capillaries in order to promote leakage of fluids of (transudate or exudates)

TRALI

TRALI: Diagnosis includes chest x-rays wherein ____ can be seen

bilateral lung infiltration

criteria are present but other causes of ALI is identified

Possible TRALI

all criteria of TRALI identified but onset is within 6-72 hours post transfusion

Delayed TRALI

nvolves patient factors that would predisposed in certain person to a case of TRALI. It involves that prime neutrophils or pulmonary endothelial cells that would activate cytokine release that would affect the endothelial lining of alveolar capillaries that would result to edema.

First hit; TRALI

TRALI signs: because of anti-HNA reacting with patient neutrophils

Transient leukopenia

t is related to the transfused product. Some factors are specific to a particular product while other are common to all product as for the case of the presence of HLA or HNA in RBC units.

Second hit

is beneficial when diagnosing to TRALI

X-ray

TRALI signs: caused by anti-HLA antibodies

Thrombocytopenia

Subtle bilateral 'white-out” appearance of CXR (Pulmonary edema)

TRALI

Most frequent infection associated with transfusion

TRANSFUSION-ASSOCIATED SEPSIS (TAS); TRANSFUSION-TRANSMITTED BACTERIAL INFECTION (TTBII)

rbc units are invaded by what bacteria

Gram-negative rods; Enterobacteriaceae

NOT HIV OR HEPA B BUT BACTERIAL INFECTION

TRANSFUSION-ASSOCIATED SEPSIS (TAS); TRANSFUSION-TRANSMITTED BACTERIAL INFECTION (TTBII)

platelet units are invaded by what bacteria

– Gram-positive cocci; normal skin microbiota; S. aureus

– over contamination or population/ growth of bacteria in the circulation due to multiple release of endotoxins

Septic shock

* Immunocompromised state * Low WBC counts

TRANSFUSION-ASSOCIATED SEPSIS (TAS); TRANSFUSION

transfusion reactions Flashcards

(64 cards)