dokdjumhanati2014

5/17/2018 DokDjumhanaTI2014

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Safe and AppropriateUse of Blood inTransfusion:Focus on dyspnea &fever complicationsDjumhana Atmakusuma

Division of Hematoloy ! "edical#ncoloy$ Department of %nternal"edicine

University %ndonesia


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Dyspnoe during and after

blood transfusion

T'A(%:

Dyspnea

)on

productive

couh

'esp

TA*#:Dyspnoe

*ouh

Anaphyla+isreactions:

BronchospasmDyspnea

Acutehemolyticreaction

Bronchospasm

Dyspnea


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Haemolytic Transfusion Reactions

Haemolytic transfusion reactions: acute and delayed

Acute reactions: fever and other symptoms/signs of

haemolysis within 24 hours of transfusion confirmed

by a fall in Hb rise in !DH positive DAT and positivecrossmatch

Delayed reactions: fever and other symptoms/signs of

haemolysis more than 24 hours after transfusion

confirmed by one or more of: a fall in Hb or failure ofincrement rise in bilirubin positive DAT and positive

crossmatch not detectable pre"transfusion# $imple

serological reactions %development of antibody without

pos DAT or evidence of haemolysis& are e'cluded#


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,%" or complement

-+in %./$ either AntiA or AntiB$ 0othactivate complementsystem ,0indin/ ofcomponents of *12complement3mem0rane attack

Fi+ation of *12 comple+

pores 5 holes onerythrocyte mem0rane 6ater enterin this canalosmotic intavascularlysis hemolo0inemia hemolo0inuria

Simpli-ed*omplement7ath6ay inHemolytic 'eaction


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Acute Hemolytic Reactions

$hoc( hypotension bronchospasm :

due to the generation of )*a dan )+aanaphylatocine complement fragment and otherinflammation mediators

,idney ischemiaAcute tubular necrosis %AT-&renal failure due to nitric o'ide binding to free Hb

)oagulation cascadeare activatedD.) )linical symptoms signs are mostly caused by

activation of cyto(ine 0networ(1: .!" .!"3 .!" T-56febrile hypotension leu(ocyte activation andcoagulation cascade


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Delayed TransfusionReactions

Mechanism Antibodies that exist in low titers prior to the

transfusion

Typically to the Kidd or RH system Upon reexposure, titer increases from memory

Bcells

!linical "icture#

Decrease in h$n, fe%er&, uncon'u$atedbilirubin, spherocytosis

Happens ()* days post transfusion


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Delayed TransfusionReactions

Treatment

As lon$ as clinically mild, no treatmentnecessary

Monitor renal function, h$n

"R++-T it from happenin$ the nexttime . R+"/RT T/ TH+ B0//D BA-K


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Acute Hemolytic 'eaction isSuspected:8HAT T# D#9

After Stop transfusion Determine: 8hat kind ofcomplication9 *linically &

la0oratory 9; #0serve


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Ta0le 8orkup of an acute transfusionreaction 341f an acute transfusion reaction occurs

)2 3top blood component transfusion immediately(2 erify the correct unt was $i%en to the correct patient

42 Maintain 1 access and ensure ade5uate urine output with an appropriate crystalloid or colloid solution

62 Maintain blood pressure and pulse

72 Maintain ade5uate %entillation

82 -otify attendin$ physician and blood ban9

:2 /btain blood ; urine for transfusion reaction wor9up


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Ta0le 8orkup of an acute transfusionreaction 3=4

1f intra%ascular hemolytic reaction is con@rmed #

)2 Monitor renal status >BU-, creastinine?(2 1nitiate diuresis a%oid uid o%erload if renalfailure is present

42 AnalyCe urine for hemo$lobinuria

62 Montor coa$ulation status >Ddimer, "T, a"TT,@brino$en, platelet count?

72 Monitor for si$ns of hemolysis >0DH, bilirubin,hapto$lobin, plasma

hemo$lobin?82 Monitor hemo$lobin and hematocrit

:2 Repeat compatibility testin$ >crossmatch?


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Ta0le 8orkup of an acute transfusionreaction 3?4

1f bacterial contamination is suspected #

)2 /btain blood culture of patient

(2 Return unit or empty blood ba$ to blood ban9for culture and ramEs stain

42 Maintain circulation and urine output

62 1nitiate broadspectrum antibiotic treatment as

appropriate# re%ise antibiotic re$imen on thebasis of microbiolo$ical results

72 Monitor for si$ns of D1!, renal failure,

respiratory failure


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How to prevent acutehemolytic reactions or other

transfusion

complications 77

Avoid clerical reactions 888

Avoid blood transfusion 888


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Dyspnoe during and after

blood transfusion

TRA!.:Dyspnea

-on

productive cough

Resp

distress

TA)9:Dyspnoe

)ough

Anaphyla'is

reactions:

ronchospasmDyspnea


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Acute transfusion reactions

Acute transfusion reactions are defined in this

report as those occurring at any time up to 24

hours following a transfusion of blood orcomponents e'cluding cases of acute reactions

due to incorrect component being transfused

haemolytic reactions transfusion"related acute

lung in;ury %TRA!.& or those due to bacterialcontamination of the component#


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Transfusion Related Acute !ung .n;ury

%TRA!.&

Transfusion Related Acute !ung .n;ury

was defined in this report as acute

dyspnoea with hypo'ia bilateral

pulmonary infiltrates during or within 3

hours of transfusion not due tocirculatory overload or other li(ely cause#


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Fever durin or after

0lood transfusion

*auses of

fever 999Fe0rile nonHemolytic

Transfusion

'eactions

BacterialSepsis

AcuteHemolytic

'eactions


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Transfusion transmitted infections

A report was classified as a TT. if following investigation:

The recipient had evidence of infection post"transfusion

and there was no evidence of infection prior to transfusion

and no evidence of an alternative source of infection !.=.T$ 59R .-5?$.9-

@hole blood/red cells

latelet concentrates

5resh froBen plasma

$TART .-5?$.9-

@ithin *C minutes ofremoving pac( from

refrigerator

.mmediately

@ithin *C minutes

)9=!>T> .-5?$.9-

@ithin 4 hours %orless in high ambient

temperature&

@ithin 2C minutes

@ithin 2C minutes


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Fe0rile nonHemolyticTransfusion 'eactions

3F)HT'4


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Fe0rile nonHemolyticTransfusion 'eactions 3F)HT'4

De-nition of F)HT':

temperature rise of more thanC* 3;CF4

typically accompanied 0y chillsand riors

occurin durin transfusion orup to E hours after transfusionhas ended

not attri0uta0le to another

cause


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Fe0rile nonHemolyticTransfusion 'eactions 3F)HT'4

7rophyla+is:

Antipyretics: Acetaminophen as prophyla+is:

evidence supportin the ecacy is

Guestiona0le

Antihistamines: no role in prophyla+is 3do not

prevent F)HT'4


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7revention of F)HT'

7revention (eukoreduction

Decrease storae time

Durin storae platelets release *DCliand 3*D14

stimulate endothelial cells produce

prostalandin @= 3simiar to pyroencytokines4


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(eukocytes 'educedBlood *omponents

; 7atients 6ho have repeatedfe0rile reactions in associations6ith the transfusion of 'B*s or

7latelets=; As prophyla+is aainst

alloimmuniIation for patients

6hom intensive or lon termhematherapy is anticipated3Anemia aplastic$

"yelodisplastic Syndrome

eu ocytes e uce


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eu ocytes e uceBlood *omponents

3('B*s4?; Still controversy: clinicalstudies ('B*s are as eJectivein preventin transmission of

*"< infection3as are 0lood components o0tained from

*"


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eu ocytes e uceBlood *omponents

3('B*s41; ('B*s: not indicated to prevent posttransfusion raft versus hostdiseases 3.


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!eu(ocytes Reduced lood

)omponents A decision to use leu(ocyte reduced

R)s or leu(ocyte reduced latelets

prophylactically in effort to prevent

alloimmuniBation should be made >59R>the 5.R$T

blood transfusion

!R)$: " R)sedside filter

" lateletsedside filter

Thrombapheresis


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Donor ApheresisDonor Throm0apheresis

)on remunerated$ voluntary donors

Donor 7lasmapheresis commercial donors plasma products3factory: human al0umin$ Factor


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'educe 7atient

@+posure to "ultipleDonors

'educe 7atient

@+posure to "ultipleDonors 7ooled platelets contain platelets$ plasma$ and

many 6hite cells from E donors

Apheresis platelets contain platelets$ plasma$ and6hite cells from only one donor

7ooled platelets contain platelets$ plasma$ andmany 6hite cells from E donors

Apheresis platelets contain platelets$ plasma$ and6hite cells from only one donor

Apheresis

7latelets:

#ne Donor

Apheresis7latelets:

#ne Donor

7ooled 7latelets:

E Donors

7ooled 7latelets:E Donors


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$ingle donor platelets

%Thrombapheresis

'educed 7lasma volume 0urden moreplasma $ more complications 3e;TA*#$ T'A(%4

(euco'educed 7latelets to prevent

alloanti0odies 6hich result in refractory toplatelet transfusion "atched platelets for refractory patients to

increase response rate to platelet transfusion

%ncrease mean time 0et6een transfusions

(euco'educed 7latelets to prevent ,fe0rilenonhemolytic transfusion reactions/3F)HT'4

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