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Flashcards in Transfusion reactions Deck (37)
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What do you do if you suspet an acute transfusion reaction?

STOP the infusion, but keep the IV line open so you can give fluids and other meds

report to the blood bank

return the unused portion to the blood bank and send additional specimens as necessary


What will the blood bank do>

1. clerical check
2. repeat ABO type and screen
3. DAT
4. Check serum color (pink-red for hemolysis if it was yellow pre-transfusion)
5. Sometimes: repeat antibody screen, gram stain, culture the unit, and do LDH, bilirubin, haptoglobin


What percentage of transfusions will have an allergic transfusion reaction?



What is an allergic transfusion reaction due to?

hypersensitivity to plasma proteins, usually cause unkown


How should you treat an allergic transfusion reactions?

antihistamine and possibly steroids if it's just mild

if it proceeds to anaphylaxis, obviously epi, trendelenburg, antihistamings, steroids,


If the reaction is only mild (just hives) and resolves with with benadryl, can you restart the transfusion?

yes - this is the ONLY instance where a transfusion can be restarted after a reaction


What group of patients with an immune deficiency can have a severe allergic reaction to blood products?

IgA deficiency (because they can develop antibodies against IgA)

so send an IgA level if someone has a severe allergic reaction


Acute hemolytic reaction occurs by definition within ___

4 hrs

but will probably happen sooner


What is the cause of hemolytic transfusion reactions?

due to the presence of a preformed antibody, usually ABO incompatibiltiy due to clerical error


WHen does a delayed hemolytic transfusion reaction usually occur?

usually 5-14 days after a transfusion


A delayed reaction is usually due to what?

formation of a new antibody


there was an amnestic response to Kidd or another antibody group


What percentage of transfusions will result in a febrile nonhemolytic transfusion reaction?



What's the presentation of a febrile nonhyemolytic TR?

fever with chills/rigors and nothing else


WHat's the cause of a febrile nonhemolytic TR?

there are either cytokines in the stored unit or antibodies in recipient plasma to antigens on donor lymphocytes, granulocytes, platelets, etc.


What are some causes of rspiratory distress associated with a transfusion?

Hemolytic rxn
transfusion associated sepsis
coincidental with underlying condition like COPD, asthma, anxiet, etc.


What is transfusion related acute lung injury?

- acute onset within 6 hrs of transfusion
- acut elung injury with hypoxemia, bilateral infiltrates on CXR, no evidence of left arterial hypertension (circluatory overload; because that would be TACO, not TRALI) with NO OTHER CAUSE for acute lung injury


TRALI wins the prize for what?

the #1 cause of transfusion-related fatality

maybe 1 in 5000 (old number)


What are the two theories for TRALI?

Immune: donor has antibodies to recipient human neutrophil antigens and forms a soluble complex that activates complement and inflammation

Non-immune: they have a pre-existing condition that activates neutrophils and then the transfused blood has accumulated lipids that further activate the primed neutrophils


What public health measure led to a decreased rate of TRALI?

we found out that most cases were coming from cases where the donor was female (and females have more antibodies)

so we've switched to allowing only males and proven nullip females


WHat is transfusion-associated circulatory overload

it's in the name - volume overload with no clear definition occuring within several hours of a transfusion

just support them through it


Which one: TACO or TRALI will respond to a diuretic

just TACO

interestingly, TRALI won't respond


What is post-transfusion purpura and when does it occur?

acute severe onset of thrombocytopenia usually 3-10 days post-transfusion


WHat is the cause of post-transfusion purpura?

usually an amnestic response to a platelet antigen that on re-exposure will cause removal of both transfused and SELF platelets

this is very rare


How will transfusion associated GVH disease present?

rash, diarrhea, liver abnormalities, pancytopenia (bone marrow aplasia)


WHen does transfusion associated GVH disease usually present?

4-30 days post transfusion


What are the indications for irradiating blood to avoid GVH disease?

congenital immunodef
all peds onc patients
stem cell transplants
on purine analog drugs in the past 12 months
for intrauterine transfusions
for granulocyte transfusions
Directed donations from family members (higher risk for GVHD)


What is alloimmunization?

it's when you develop antibodies from getting a transfusion. we try to avoid this as much as possible


Wat are the current infectious testing we do on donated blood?

Hep B
Hep C
HTLV1 and 2
west nile
bacterial testing of platelets


Why are transfusion associated sepsis reactiosn more common with platelet transfusions?

they need to be stored at room temperature

why we spin them and why we can only keep them for 5 days


How does a sepsis reaction present?

fever, hypotension, shock, nausea, vomiting, respiratory symptoms, coagulopathy