Resp: Transfusion Med Ii: Transfusion Reactions

Front 1

types of transfusion reactions

Back 1

acute (w/in 24 hours)
delayed (>24 hrs)

-immunologic
-nonimmunologic

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protocol for ATR

Back 2

-stop
-IV
-pt ID
-call BB
-send blood and urine
-send blood unit and fluid
-support pt

Front 3

immunologic ATR

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hemolytic (AHTR)
febrile (FNHTR)
allergic/anaphylactic
TRALI

Front 4

non-immuno ATR

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TACO
hemolytic
bacterial contamination
air embolus
metabolic reactions

Front 5

AHTR:
cause

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transfused RBCs react with pt preformed Abs

Front 6

AHTR:
reaction

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-activate many inflamm pathways and the coAg pathway
-RBC membranes are rich in lipids and the release of lipids activates:
-kinin (hypoTN)
-C' (hemolysis, RBC removal)
-CoAg (bleeding)
-cytokines (fever, hypoTN, mobilization of cells)
-renal failure

Front 7

FNHTR:
presentation

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>1 degree rise in temp
-accompanied by chills, rigors, discomfort
-within 1-2 hours

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FNHTR:
effect

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-depends on type and age of component
-platetet > RBCs
-old > new; secondary to the build up of biological response mediators in products which have not had WBCs removed

Front 9

FNHTR:
RBC vs platetets

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RBC: rule out other, admin antipyretics

platelets: manage according to severity, bac contamination

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allergic/anaphylactic transfusion reaction:
cause

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interaction b/w allergen and preformed pt IgE Ab
-allergen: plasma pr, drug, food

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allergic/anaphylactic transfusion reaction:
symptoms

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uticaria
anaphylaxis (volume expansion and epi)

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allergic/anaphylactic transfusion reaction:
tx

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antihistamines, vol expansion, epi

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TRALI:
what is it?

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-bilateral pulmonary edema with severe hypoxemia

Front 14

TRALI:
signs and symptoms

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fever, tachycardia, hypoTN
-1-2 hours, always within 6 hours

-neutros agglut in small blood vessels (systemic but most obvious in alveolar air spaces)

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TRALI:
cause

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immune-mediated even with pathological Abs typically of donor origin
-Abs directed against HLA or granulocyte Ags
-lipids accumulate in blood during storage

-neutrophil priming and endothelial activation - leads to TRALI

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TRALI:
Tx

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resp/CV support
-if pts Abs: leuko-reduction of blood products for future transfusion

Front 17

bacterial contamination ATR:
cause

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-platelets stored at room temp
-gram + with coagulase - staph

(RBC: yersinia enterocollitica)

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bacterial contamination ATR:
symptoms

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fever, rigors, shock, DIC, renal failure

Front 19

bacterial contamination ATR:
Tx

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broad spec antibiotic coverage started immediately

Front 20

TACO:
what is it?

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circulatory overload
pts with diminished cardiac reserve, chronic anemia, massive transfusion, infants

Front 21

TACO: symptoms

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dyspnea
orthopnea
tachycardia
cyanosis
inc BP
pulmonary/pedal edema

Front 22

how to prevent TACO

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transfuse SLOWLY
1mL/kg/hr not exceeding 4 hour/unit

Front 23

non-immune hemolytic reaction:
what is it?

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hemolyosis that occurs when RBCs transfused w/ improper storage or manipulation during processing

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causes of non-immune hemolytic reaction: causes

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>37 degrees
freeze/thaw lesion
hypotonic soln
thru small filter or needle
impropter deglycerolization
drug

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predispositions to non-immune hemolytic reaction

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Hbopathies
microangiopathic hemolytic anemia
abnormal heart valve functioning
infections

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Air embolus seen in setting of

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intra-op salvage
rapid infusion

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examples of metabolic reactions

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hypocalcemia
hyperkalemia
hypokalemia

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cause of hypocalcemia

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-rapid infusion of citrated blood
-alkalosis causes dec in ionized Ca+

Front 29

symptoms of hypocalcemia

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perioral tingling
muscular cramping
frank tetany

Front 30

cause of hyperkalemia

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with massive transfusion or older stored RBC components

rare (except in anhepatic phase of liver transplantation)

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causes of hypokalemia

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rapid infusion of citrated blood leading to metabolic alkalosis

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immunological DTR

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alloimmunization
hemolytic
graft v host
posttransfusion purpura

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nonimmuno DTR

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iron overload
viral infections
other infections

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cause of alloimmunization DTR

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bodys immune system attacks foreign Ag by devo Abs
-RBC or HLA Ags

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signs and symptoms of alloimmunization DTR

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platelet transfusion refractoriness
hemolysis or shortened life span
+ direct Antiglobin test
+ Ab screen

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what is TA-GVHD

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engraftment of transfused donor lymphocyte in pt that does not recognize transfused lymph as foreign so donor cells attack pts cells

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TA-GVHD:
signs and symptoms

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BM, skin, intestinal musocsa, hepatocytes
90% fatal

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TA-GVHD
prevention

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gamma irradiation of all WBC-containing pts at risk
-SCtransplant
-immunodef
-receiving blood components

Front 39

what is PTP

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post-transfusion purpura
-in pts that lack HPA-1A (PLA1)

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PTP signs and symptoms

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abrupt onset of severe thrombocytopenia (10 days after)
-3 weeks - self limiting

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PTP tx

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self limiting
-IV immunoglobin and/or plasmapheresis

Front 42

iron overload seen in what pts?

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chronically transfused but not concurrently bleeding

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RBC unit = ? iron

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200 mg (1mg/mL RBC)

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symptoms of iron overload

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-seen after 50 units
-iron deposits in RES and other tissues causing organ damage

-seen in heart, liver, pituitary gland

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tx for iron overload

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iron chelator: desferrioxamine

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TTVI:
window period

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delay when donor is infected and when test is + for infection

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TTVI chances:
HIV

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1:2-4 mill

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TTVI chances:
HCV

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1:1 mill

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TTVI chances:
HBV

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1:250000

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TTVI chances:
HTLV1

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1:641000