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47 Cards in this Set

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Hemolysis in Immediate Hemolytic TR?

Intravascular hemolysis

Cause of IHTR

  • ABO in compatibility

  • Potent Alloantibodies (Anti-Vel and anti-PP1Pk)

Is IHTR complement mediated?

Yes

  • Fever with or with out chills (80%)
  • Hemoglobinuria and Hemoglobinemia
  • Chest, Abdominal and/or back pain
  • Pain/warmth at IV site
  • SOB
  • Tachycardia
  • Anxiety
  • Olgiuria/with Renal Failure, DIC, Shock

IHTR

Onset of IHTR

acute/immediate

DHTR onset

at least 24 hours after transfusion usually 2-14 days

Cause of DHTR

  • Donor cells coated with patient Ab and removed by extravascular hemolysis
  • Ex: anti-JK, anti-Rh, anti-Fy
  • Other alloantibodies

Hemolysis in DHTR

Extravascular


  • Fever (increase 1C)
  • Drop in H&H
  • Jaundice (increased bilirubin)

DHTR

Recommendations for future transfusion in DHTR

Ag negative rbcs

  • Itching hives
  • Rash
  • Raised Red areas on skin
  • Flushing

urticarial

Cause of urticarial reaction

  • Patient Ab to donor plasma protein
  • Pre-exsisting IgG/IgE or both in patient

Recommendations for future transfusion with urticarial reaction

  • Treat patient with antihistamines prior to transfusion
  • Washed red cells/platelet products
  • PAS platelets

What type of transfusion reaction can be restarted?

Urticarial

Onset of Anaphylactic

  • During transfusion; after a few mls are transfused

Which reactions occur after a few mLs of transfusion

  • Anaphylactic
  • Bacterial Sepsis


  • SOB
  • Bronchospasms
  • Wheezing and coughing
  • cyanosis
  • hypotension
  • angioedema
  • nausea
  • larynegeal/pharyngeal shock

Anaphylactic

Cause of Anaphylactic reaction

  • Most common: anti-IgA (IgE mediated)

  • Antibody to donor plasma proteins

  • Other: Ab to haptoglobin, penicillin, latex or C4

Recommendations for future transfusion with an anaphylactic reactions

  • Avoid plasma transfusions
  • All future products: IgA negative units
  • 2-3L washed RBC/platelets
  • Fever with or without chills
  • Nausea
  • vomiting
  • headache
  • anxiety
  • shaking (uncommon)

Febrile Non-Hemolytic (FNH)

Cause of FNH

  • Antibody to donor leukocytes; HLA
  • Anti-platelets
  • Accumulated cytokines in bag

Recommendations for future transfusions in FNH reaction

  • Leuko-reduced blood; <5X10^6
  • Premedicate with aspirin free antipyretic

Onset of Bacterial sepsis

  • Acutre rapid onset within a few mLs of transfusion


  • High fever, chills
  • Hypotension
  • True rigors
  • hemoglobinuria
  • renal failure
  • shock
  • DIC

Bacterial sepsis

Causes of bacterial sepsis

  • Bacteria in blood

TRALI

Transfusion related lung injury


  • Respiratory distress/dypsnea
  • Severe hypoxia (cyanosis)
  • Fever
  • Chills
  • hypotension
  • bilateral pulmonary edema

TRALI

Onset of TRALI

within 1-2 hours up to 6 hours post transfusion

Cause of TRALI

  • associated with components containing plasma
  • Donor Ab to: Human Neutrophil antigen or anti-HLA Ab

Recommendations for future transfusions in TRALI


  • Stop transfusion
  • Start Oxygen therapy
  • Plasma units from Donor: Male blood donor, never pregnant female, Females negative for HLA Ab

DSTR

delayed serological transfusion reaction

6 tests for viral markers the must be performed on donor units (besides NAT)

  • Anti-HTLV I and II
  • Anti-HCV
  • Anti-HBC
  • Anti-HIV 1&2
  • Serologic test for syphilis

Follow up tests after a transfusion reaction

  • Send out units: GS and culture
  • Urine Hgb
  • Repeat: ABO/Rh, Ab screen, complete crossmatch
  • Monitor H&H, haptoglobin

Unintended, undesirable occurence before, during, or after transfusion

Adverse event

Undesirable response or effect in a patient with blood components

Adverse reactions

any error or accident that could effect the quality or efficacy of blood components or transfusions

Incident

Immunologic transfusion reaction

  • IHTR
  • Anaphylatic
  • FNH
  • Allegric/Utricarial
  • DHTR
  • TRALI

Non-immunologic Transfusion reaction

  • TACO

  • Bacterial contamination

  • Hypothermia

  • Hemolysis with out fever or symptoms

Transfusion reactions with fever

  • IHTR
  • DHTR
  • FNH
  • Bacterial sepsis
  • TRALI

Cause of DSTR


  • Rapid development of antibodies w/o lab evidence of hemolysis
  • No signs/symptoms
  • Not 1st exposure to an antigen

TACO

Transfusion circulatory overload

Onset of TACO

soon after transfusion

Cause of TACO

volume overload


  • Hypotension
  • Headache
  • CHF
  • dyspnea
  • cyanosis
  • productive cough w/ pink forthy sputum
  • renal failure

TACO

Treat TACO

sit patient upright, admin O2, IV diuretics

Iatrogenic:


  • mechanical in nature/overheating
  • osmotic damage
  • using needle with too small a bore to transfuse

Considerations for future transfusion in iatrogenic (hemolysis w/o fever or symptoms)

Transfuse RBC only with normal saline


QC blood warmers