Transfusion Reactions

Question 1

Occurs soon after the transfusion of incompatible cells

Answer 1

Immediate hemolytic transfusion reaction (IHTR)

Question 2

Red cells are rapidly destroyed

Answer 2

Immediate hemolytic transfusion reaction (IHTR)

Question 3

Signs and symptoms occurs within minutes or 1-2 hours of transfusion

Answer 3

Immediate hemolytic transfusion reaction (IHTR)

Question 4

What is seen in an IHTR under anesthesia?

Answer 4

Hemoglobinuria, abnormal bleeding at surgical wound, and hypotension

Question 5

What occurs within minutes and causes shock, renal failure, DIC, possible death?

Answer 5

ABO incompatible transfusions

Question 6

What the common antibodies that cause IHTR?

Answer 6

Anti-A, anti-K, anti-Jka, anti-Fya

Question 7

What do the antibodies that cause IHTR do?

Answer 7

Anti-A, anti-K, anti-Jka, and anti-Fya bind complement to red cell surfaces and cause in-vitro lysis

Question 8

What type of hemolysis occurs in an IHTR?

Answer 8

Intravascular or Extravascular

Question 9

What happens during an immediate intravascular hemolytic transfusion reaction?

Answer 9

intravascular cell lysis that releases hemoglobin, causing hemoglobinemia and hemoglobineuria

Question 10

What happens during an immediate extravascular hemolytic transfusion reaction?

Answer 10

Ag-Ab complex formation on red cells with incomplete complement activation (no cell lysis)

Question 11

What are the signs and symptoms caused by IHTR?

Answer 11

Fever, chills, chest pain, back pain, hypotension, abdominal pain, hemoglobinemia, hemoglobinuria, etc

Question 12

What to do when there’s an IHTR?

Answer 12

STOP the transfusion, keep IV open with saline, perform clerical checks, return unit, collect appropriate specimens for evaluation

Question 13

What therapy is done for immediate intravascular hemolytic transfusion reaction?

Answer 13

prevent renal failure, treat hypotension with IV, and blood component therapy

Question 14

immediate extravascular hemolytic transfusion reaction

Answer 14

Does not require therapy; just monitor vital signs, coag studies and renal output

Question 15

How to prevent transfusion reactions?

Answer 15

Store red cells only in blood bank monitored refrigerators, never warm cells above 37C, don’t transfuse if patient or donor ID is not accurate

Question 16

What are the two types of delayed hemolytic transfusion reactions (DHTR)?

Answer 16

Secondary response to transfused red cells (3-7 days later) & primary alloimmunization (no past history of preg, transfusion or transplant)

Question 17

What are the signs and symptoms of DHTR?

Answer 17

Complement not activated so no intravascular hemolysis; mild fever, fever with chills, moderate jaundice

Question 18

What to do when there’s a DHTR?

Answer 18

Initiate post-tranfusion reaction protocol (blood speciments should be sent for post-transfusion reaction workup); patient should be observed

Question 19

What is the therapy for DHTR?

Answer 19

Symptomatic anemia should be treated with red cell transfusion

Question 20

What are the 7 immediate non-hemolytic transfusion reactions?

Answer 20

1. Febrile non-hemolytic transfusion reaction (FNHTR)
2. Allergic
3. Anaphylactic and Anaphylactoid
4. TRALI
5. TACO
6. Bacterial contamination
7. Physically or Chemically induced transfusion reaction (PCITR)

Question 21

What causes Febrile?

Answer 21

Leukocyte antibodies present in patient’s plasma

Question 22

What units do you give to patients with febrile?

Answer 22

RBC-leukocyte reduced

Question 23

How do you treat allergic transfusion reactions?

Answer 23

Antihistamines (Benadryl)

Question 24

Is there fever in anaphylactic or anaphylactoid transfusion reactions?

Answer 24

No

Question 25

a serious blood transfusion complication characterized by the acute onset of non-cardiogenic pulmonary edema

Answer 25

TRALI

Question 26

How do you determine if it's TRALI?

Answer 26

The presence of leukocyte antibodies in transfused plasma

Question 27

What causes TACO?

Answer 27

Physician-transfusion reaction when unit is transfused at too fast a rate (they overload in children, elderly and patient with chronic anemia, cardiac disease, thalassemia major or sickle cell disease)

Question 28

What should you do if patient has a history of TACO?

Answer 28

Transfuse at 100 mL/hr or less

Question 29

Sepsis, dryness and flushing of patient skin, fever, hypotension, shaking chills, muscle pain, vomiting, cramps, bloody diarrhea

Answer 29

Symptoms of bacterial contamination

Question 30

dyspnea, coughing, cyanosis, orthopnea, chest discomfort, headache, restlessness, tachycardia, systolic hypertension, and abnormal EKG results

Answer 30

Symptoms of TACO

Question 31

chills, cough, fever (one of the few to have fever), cyanosis, hypotension, and increasing respiratory distress shortly after transfusion of blood components

Answer 31

Symptoms of TRALI

Question 32

Ranges from hives and itching to shock and death

Answer 32

Symptoms of Anaphylactic and Anaphylactoid Reactions

Question 33

Swelling and raised red welts that may itch, fever may or may not be present

Answer 33

Symptoms of allergic transfusion reactions

Question 34

fever with or without chills, rarely hypotension, most symptoms are mild and benign, severe reactions: hypotension, cyanosis, tachycardia, tachypnea, dyspnea, cough, limited fibrinolysis and transient leukopenia

Answer 34

Symptoms of febrile

Question 35

facial numbness, chills, generalized numbness, muscle twitching, cardiac arrhythmias, nausea, vomiting, anxiety

Answer 35

Symptoms of PCITR

Question 36

What happens to RBCs in PCITR?

Answer 36

Physical damage to RBCs leading to abnormal cells

Question 37

How do you avoid PCITR?

Answer 37

Precautionary measures

Question 38

What are the 5 delayed non-hemolytic transfusion reactions?

Answer 38

1. Alloimmunization 2. Post-transfusion purpura (skin hemorrhages) 3. Transfusion-Associated Graft vs. Host Disease (TA-GVHD) 4. Iron Overload 5. Immunosuppression

Question 39

What are the immediate lab procedures after transfusion reaction?

Answer 39

- Clerical checks - Visual inspection of serum and plasma for free hemoglobin and hemolysis (pre and post transfusion) - DAT on POST TRANSFUSION SPECIMEN

Question 40

What are the "as required" procedures after transfusion reaction?

Answer 40

- ABORh on pre and post - Crossmatch on pre and post - ABS on pre and post - ABID - Antigen typing - Check for free hemaglobin in first voided urine post - Check for unconjugated bilirubin 5-7 hours post-transfusion

Question 41

What are the extended procedures after transfusion reaction?

Answer 41

- Gram stain and bacterial culture - Serum hgb - Serial hgb, hct, and platelet count - Peripheral blood smear

Question 42

What happens if there's a positive DAT in post-transfusion specimen?

Answer 42

Perform an elution and determine specificity; repeat DAT on several specimens to detect rising antibody titers

Question 43

What happens if there's a negative DAT in post-transfusion specimen?

Answer 43

If there's hemolysis, perform an elution; repeat DAT later on a new specimen

Question 44

What if there's too few antibody molecules to detect in a negative DAT?

Answer 44

Elution and concentrate antibody

Question 45

What causes false negative antibody screens?

Answer 45

- Failure to detect alloantibody in original test - Test not sensitive enough to detect alloantibody - Clerical or technical error - Antibody screening cells represented a single dose of antigen - Antibody identified in post only (due to anamnestic response or patient ID problem)

Question 46

What do you check for in first voided post-transfusion urine?

Answer 46

Free hemoglobin (hemoglobinuria)

Question 47

What do you check for in the post-transfusion urine one week later?

Answer 47

hemosiderinuria