Transfusion Reactions Flashcards
(20 cards)
What types of transfusion reactions are there?
Acute haemolytic transfusion reaction
Allergic/ anaphylaxis
Febrile non-haemolytic transfusion reactions
Transfusion related acute lung injury (TRALI)
Transfusion related fluid overload (TACO)
GvHD
Bacterial contamination - greatest risk with platelets
What causes an acute haemolytic transfusion reaction?
Intravascular haemolysis usually due to ABO incompatible reaction
When do symptoms occur after an acute haemolytic transfusion reaction?
Minutes after transfusion started
What symptoms occur with an acute haemolytic transfusion reaction?
Fever Hypotension Tachycardia Flank pain Haemoglobinuria
Why can an allergic/ anaphylactic reaction occur?
Due to reaction to components within transfusion e.g foreign plasma proteins or antibodies to IgA
What symptoms are seen in allergic/ anaphylactic reaction?
Urticaria Pruritis Angioedema Hypotension Wheezing
What is a febrile non-haemolytic transfusion reaction?
More than 1 degree increase in temperature with no other medical explanation.
- may also have slight increase in pulse and respirations
- can be due to cytokines released in blood products or due to sensitisation by previous pregnancies or transfusions
What is transfusion related acute lung injury (TRALI) thought to be due to?
Transfused leukocyte antibodies
What symptoms can TRALI cause?
Dyspnoea
Hypoxia
Non- cardiogenic pulmonary oedema
Is it easy to distinguish between TRALI and TACO?
Not always
What is TACO?
Fluid overload resulting in pulmonary oedema
- as well as features of pulmonary oedema, patient may also be hypertensive
Who is at risk of transfusion associated graft versus host disease?
Immunosuppressed patients
What features should alert you to an acute transfusion reaction?
Increased temperature Collapse Pain - chest, loins, back, extremities Rigors Anaphylaxis Shivering Drop in BP SOB Flushing Burning pain at drip site Bleeding from drip site Patient reports general feeling of apprehension Non specific deterioration in patient condition Dizziness
What is the first thing that should be done if patient exhibiting possible features of an acute transfusion reaction?
STOP THE TRANSFUSION
Rapid clinical assessment, check patient ID/blood compatibility label
Inspect - examine component bag for abnormal appearance (clumps, particles, discolouration) and check IV site for infection
If patient having an anaphylactic reaction, what should you do?
STOP TRANSFUSION
Anaphylaxis pathway
Oxygen
Give IM adrenaline
If acute haemolytic transfusion reaction or sepsis, what should be done?
IV saline
Sepsis pathway if sepsis
If patient is breathless what may be reason?
Related to transfusion or underlying illness?
TACO
TRALI
Anxiety
What initial investigations should be done if patient breathless?
Stop transfusion Check identity Maintain venous access Oxygen sats CXR ECG
What are the early features of transfusion associated graft versus host disease?
Fever
Maculopapular rash
Diarrhoea
Hepatitis
Bone marrow involvement - profound pancytopenia (death from infection usually within 2-3weeks)
Does pre storage leukocyte depletion totally remove risk of TA GvHD?
No - at risk patients need irradiated red cells, platelets and granulocyte concentrates
