Path 3 Ex 3

Front 1

what is the • Most fatal Hemolytic Transfusion Reactions due to clerical errors outside the blood bank

Back 1

Acute Hemolytic Transfusion Reactions (HTR) due to ABO

Front 2

What is the cause of Acute Hemolytic Transfusion Reactions (HTR)

Back 2

• Preformed RBC antibody + incompatible RBC expressing antigen (ex: patient with anti-A getting RBC with A antigen or : Group O person accidentally given Group A RBC

Front 3

What does can cause Acute Hemolytic Transfusion Reactions (HTR)

Back 3

10-15 mL

Front 4

What are the symptoms associated with Acute Hemolytic Transfusion Reactions (HTR)

Back 4

Intravascular Hemolysis, Fever
Hypotension, Shock
Bleeding
Back pain, pain at infusion site
Pink/ Red Urine
Anxiety

Front 5

Intravascular hemolysis causes most of the symptoms of acute Hemolytic Transfusion Reactions (HTR) how?

Back 5

-C3a is released to plasma, and C3b is deposited on rbc
-C5a released into plasma. Both C3a and C5a are potent mediators of hypotension
-C5b-9) form membrane attack complex leading to rbc lysis which leads to the release of free Hb (hemoglobinemia, hemoglobinuria)
-• IgM antibody (ABO incompatibility)

Front 6

what are the complications of Acute Hemolytic Transfusion Reactions (HTR)

Back 6

-Hypotension can lead to renal ischemia which can lead to acute renal failure
--Hemoglobin scavenges nitric oxide (potent vasodilator), which promotes renal vasoconstriction and tubular necrosis
-The coagulation cascade may be activated as well, initiating disseminated intravascular coagulation (DIC).

Front 7

what are the steps taken in the lab to determine Acute HTR

Back 7

• Clerical check-compare all paperwork and records associated with transfusion: correct patient identified? Signs of specimen mishandling?
• Rule out hemolysis—spin down post-transfusion sample and look at plasma for pink-red color
• DAT—direct antiglobulin test: look for IgG or Complement coating patient RBC
• Visual inspection of unit—is unit hemolyzed?
• Further testing as indicated (panel) to define antibody specificity

Front 8

signs of hemolysis on post-transfusion specimen with a negative DAT

Back 8

• Intravascular Hemolysis related to Acute Hemolytic Transfusion Reactions (HTR)

Front 9

– Hyperbilirubinemia
– Macrophages consume rbc
– IgG antibody

Back 9

Extravascular Hemolysis: can occur with acute HTR, but less common

Front 10

Extravascular Hemolysis laboratory workup will show

Back 10

– +hemolysis
– +/-DAT
– Ineffective transfusion
– Fever, jaundice
– Not usually fatal

Front 11

o Intravascular hemolysis related to Acute HTR tx

Back 11

o Stop transfusion
o Support BP
o Maintain urine output of greater than >100 mL/hr for 24 hrs to prevent renal failure using IV fluid, diuretics and sometimes pressors (low dose dopamine)
o Platelets, cryo, FFP for critical bleeding

Front 12

o Extravascular hemolysis tx

Back 12

o Stop transfusion
o Monitor hct
o Rarely need specialized treatment
o May need additional transfusions

Front 13

• Primary or anamnestic response to alloantigen

Back 13

Delayed Hemolytic Transfusion Reactions manifested by • Extravascular hemolysis

Front 14

Delayed Hemolytic Transfusion Reactions signs and symptoms

Back 14

none, fever (>1 C), jaundice, drop in hemoglobin, + DAT (new)

Front 15

Delayed HTR Lab evaluation
• Post transfusion serum:

Back 15

– Hemolysis check, DAT
– test for unexpected alloantibodies (panel)
– Repeat Ab screen on pretransfusion specimen to r/o error

Front 16

Delayed HTR tx

Back 16

transfusion of compatible RBC lacking inciting antigen

Front 17

allergic Transfusion Reactions rxns develop when

Back 17

o Antibody to donor plasma proteins and results in o Urticaria, pruritis, flushing

Front 18

o Anaphylactic Transfusion Reactions develop when

Back 18

o Antibody to donor plasma proteins (IgA, C4, haptoglobin)
o Hypotension, urticaria, bronchospasm, local edema, anxiety

Front 19

Anaphylactic Reaction Evaluation

Back 19

R/O Hemolysis (DAT, visual inspection)
Quantitative IgA
If absent, anti-IgA warranted
IgA deficiency: 1:700

Front 20

what is the tx for Anaphylactic Reaction

Back 20

• Airway
• Fluids
• Epinephrine
• Antihistamines, corticosteroids
• Washed components, limited plasma
• IgA deficient components

Front 21

Transfusion Related Acute Lung Injury (TRALI) is considered when

Back 21

– Acute respiratory insufficiency disproportionate to amount of blood transfused

Front 22

– Chills, fever, hypotension, usually within 1-2 hrs after transfusion

Back 22

Transfusion Related Acute Lung Injury (TRALI)

Front 23

– X-Ray c/w bilateral pulmonary edema without evidence of cardiac failure or other cause for respiratory failure (looks like ARDS)

Back 23

Transfusion Related Acute Lung Injury (TRALI)

Front 24

what are the mechanisms of Transfusion Related Acute Lung Injury (TRALI)

Back 24

– Donor HLA or neutrophil antibodies react with recipient wbc
– Recipient HLA or neutrophil Ab vs. donor wbc (rare)
– Both lead to increased permeability of pulmonary microcirculation

Front 25

Suspected TRALI Investigation

Back 25

• R/O other reasons for pulmonary edema/ARDS (must be non cardiogenic)
• Clerical check, hemolysis, DAT
• Notify blood supplier: donor testing for anti-HLA and neutrophil antibodies
• If donor has Ab, will be permanently deferred
• If really TRALI, usually need oxygen
• IV steroids--controversial
• Adequate pulmonary function usually recovered in 2-4 days
• Observed mortality <10%

Front 26

• Defined as temperature increase of > 1C associated with transfusion
• Often accompanied by chills and/or rigors

Back 26

Febrile Nonhemolytic Transfusion Reactions (FNHTR)

Front 27

what increases the risk of Febrile Nonhemolytic Transfusion Reactions (FNHTR)

Back 27

• Previous alloimmunization to HLA

Front 28

Febrile Nonhemolytic Transfusion Reactions (FNHTR) can lead to complications like

Back 28

cause significant discomfort, hemodynamic or respiratory compromise

Front 29

how is blood storage related to Febrile Nonhemolytic Transfusion Reactions (FNHTR)

Back 29

• Cytokines accumulating in bag during storage• Antibodies in recipient plasma react with antigens on donor wbc or platelets

Front 30

• Bacterial contamination: one of the first recognized complications of transfusion

Back 30

Septic Transfusion Reactions

Front 31

Septic Transfusion Reactions greatest risk is with

Back 31

platelets:

Front 32

How is blood infected by bacteria?

Back 32

• Bacteria originate from donor: skin or unsuspected bacteremia
• Bacterial multiplication more likely in components stored at room temperature

Front 33

Yersinia enterocolitica, Serratia liquifaciens infect

Back 33

• RBC:

Front 34

Enterobacteria (Klebsiella,E.coli), Streptococcus infect

Back 34

• Platelets

Front 35

whats the tx for septic shock?

Back 35

• Gram stain and culture of bag and recipient
• Immediate treatment with iv antibiotics