1 transfusion reactions. 2 introduction blood transfusion is safe, effective way to correct...
TRANSCRIPT
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Transfusion Reactions
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Introduction
• Blood transfusion is safe, effective way to correct hematology defects and crucial part of supportive care of some patients
• Sometimes unwanted results may occur during or after transfusion
• One of these is transfusion reactions
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Transfusion Reactions
• They are adverse reactions associated with the transfusion of blood and its components
• 3% of individuals receiving blood transfusions have a transfusion reaction
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Transfusion reactions
• Non-threatening to fatal (Fatal ~ 1/50000)
• Immunological or Non-immunological
• May or may not cause RBC destruction
• Immediate to delayed– Immediate – rapid onset (<24 hours) – Delayed – >24 Hours,Occur days, weeks,
• May involve infectious agents
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Transfusion Reactions
• Most common causes of transfusion related DEATHS:
1. Improper specimen identification
2. Improper patient identification
3. Antibody identification error
4. Crossmatch procedure error
• Most transfusion reactions (not all) are the result of human error.
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Immediate
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Immediate Hemolytic Reactions
• Most common cause is ABO incompatibility (clerical error)
• Red cell destruction due to complement activation by IgM
• RBCs hemolysed due to reaction between Abs in recipient (A & B) & Ags on donor’s RBCs
• As little as 10-15 mL can trigger a reaction
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Symptoms
• Fever• Pain at infusion site• Back/chest pain
• Physical signs– Fever– Hypotension– Bleeding– Renal failure– Hemoglobinuria
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Steps taken if hemolytic reaction is suspected
• Stop transfusion
• Keep IV line open with physiologic saline
• Perform bedside clerical checks
• Contacts patient’s physician & blood bank
• Return unit, set & attached solutions to Lab
• Collect suitable blood samples for evaluation
– Microbiological on unit, culture of patient’s blood, Check for DIC, Renal function
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Treatment
• Treat hypotension by fluid replacement
• Maintenance of renal blood flow
• Replacement of depleted coagulation factors
• Dialysis in case of renal failure
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Transfusion of RBCs Allo-Abs
• Rarely, patient’s red cells can be hemolyzed by Abs in transfused whole blood or plasma
• Caused by anti-A or Anti-B in certain plasma products– Cryoprecipitate– Factor VIII or IX
• Positive DAT, Anti-A or Anti-B can be eluted from red cells
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Transfusion Induced Alloimmunization
• Ags are administered during transfusion
• In 1st transfusion Induce alloantibodies
• This will cause problems in subsequent transfusions
• Prior transfusion beneficial in some cases– E.g. renal transplantation is more successful
in patients with prior multiple transfusions
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Pseudo-Hemolytic Reactions
• Some transfusions may appear to be immediate HTR, but they are not due to immune RBC destruction
• These are called pseudo-hemolytic TR
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Manifestation Possible Mechanism
Hemolysis 1- Excessive Infusion pressure
2- Infusion through small pre needles
3- Overheating of donor red cells
4- Infusion of congenitally abnormal red cells
5- Freezing of red cells prior to infusion
6- Infusion of RBCs damaged by microorganisms
Hypotension or Shock
1- Infusion of infected blood products
2- Anaphylactic reactions
Fever 1- Febrile reaction
2- Infusion of infected blood
Hyperbilirubinemia 1- Infusion of large quantities of blood stored for 4-5 weeks
2- Infusion of hemolysed blood
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Delayed Hemolytic Transfusion Reactions
• DHTRs occur at least 24 hrs after transfusion
• Mediated by IgG antibodies– Patient previously exposed to RBC antigen
and has low antibody titer until exposed again
• Cannot be detected in crossmatch
– Rh, Kidd, Duffy, and Kell
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• Patients have no symptoms
• The only indication is a fall in hemoglobin
• Diagnosis made by re-crossmatch– DAT is usually positive
• Elutions are performed to identify Ab
Delayed Hemolytic Transfusion Reactions
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White Cell ReactionsFebrile Reactions
• Most common, 2% of all transfusions• Caused from HLAs on the WBCs of the donor
that react with the recipient antibody• Any component that contains WBCs could
cause FNHTRs• Cytokines IL-1, 6,8 and Tnf-alpha generated in
stored blood/products.• Determining factor is age of blood products• Leukocytes reduced units may be given
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Pulmonary Infiltrates
• Transfusion Related Acute Lung Injury• Can be due to:
– Hypervolemia– Donor antibodies that react with the recipient’s
granulocytes or vice versa• which cause embolism to blood vessels in lung tissue• Then fluids and proteins leak into alveolar space/ interstitium
• The lungs fill with a high-protein fluid• Patient displays acute respiratory insufficiency
with x-ray showing pulmonary edema without cardiac failure
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Graft-versus-Host Disease
• Rare but fatal condition that has a 90% mortality rate
• May be caused by donor lymphocytes transfused into an immunocompromised recipient– acute graft-versus-host-disease is characterized by
selective damage to the liver, skin and mucosa, and the gastrointestinal tract
• Any components that contain T-lymphocytes should be irradiated to prevent GVHD
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Platelet ReactionsPost Transfusion Purpura (PTP)
• PTP characterized by severe consumptive thrombocytopenia
• Typically in women with a history of pregnancy, immunized with Human platelet Specific Alloantigen (HPA)
• Thrombocytopenia is self-limiting and lasts for 2-6 weeks
• Occur in patients who are negative for HPA-1a
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Plasma Protein ReactionsAnaphylaxis
• Cause• Infusion of IgA proteins into Pt with IgA
antibodies• IgA deficiency about 1 in 700• Hypotension and bronchospasm• Transfusion should be stopped immediately• IgA deficient patients should be transfused with
blood products lacking IgA
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Urticaria
• Second most comon type of TR• Characterized by a pruritic rash during or
following transfusion• Allergic reactions are IgE mediated. • These reactions are usually attributed to
hypersensitivity to soluble allergens found in the transfused blood component.
• Associated with anti-IgA in recipients who are IgA deficient.
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Urticaria
• If not accompanied by other signs or symptoms, transfusion can be continued
• Anti-histamines are given