Blood Transfusion Reactions Flashcards Preview

Year 3 - CR > Blood Transfusion Reactions > Flashcards

Flashcards in Blood Transfusion Reactions Deck (48)
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1

What are non infectious complications of transfusion

Immune - Wrong blood (ABO incompatible)
- DHTR - other red cell antibodies - Rh system, kell
- FNHTR
- urticatial rash
- IgA deficiency
- PTP
- TRALI
- TA-GVHD
- Immunomodulation

non immune
- iron overload
- Fluid overload (TACO)

2

What are infectious complications of transfusion

- Viral HBV, HCV, HIV, HTLV, CMV, EBV
- bacterial
- syphilis
- parasites - malarai trypanosomiasis
- prions

3

how many people are
- A
- B
- AB
- O

- A - 42%
- B - 9%
- AB - 3%
- O - 46%

4

are you born with AB antigens

- you become exposed to AB antigens as you grow older so by about 26 months you have antigens against them

5

if you are rhesus negative how do you get rhesus positive antigens

- pregnancy
- transfusion
- transplant

6

What happens in an ABO mismatch

- There is complement activation

7

describe complement activation in ABO mismatch

Anti A and Anti B can be IgM or IgG
- the IgM antibodies can activate complement membrane complex punching holes in the surface of red cells and you get acute intravascular haemolysis
- you can get activation of complement
- this leads to coagulation, inflammation, platelet aggregation, lung oedema,
- mast cells can be activated and this causes activation of histamine and other vasoactive amines which causes cytokine release which lowers blood pressure
- this can lead to shock and eventually renal failure

8

if you give the wrong blood it can be

fatal

9

How quickly does acute haemolytic reaction occur after transfusion

- quickly - around 15 minutes

10

name the symptoms of acute haemolytic reaction

- Shock
- high fever
- kidney failure
- death

11

What is the most common near miss in transfusion

- Wrong blood in tube (WBIT) 62.8% is most common near miss

12

How can you get wrong blood in tube

 Wrong patient details put on x-match sample
 Lab - muddle up 2 patients’ samples or results (uncommon)
 At bedside, wrong unit of blood collected and given to patient - not checked thoroughly (commonest)

13

What is the management for a wrong blood transfusion

 STOP Blood Transfusion
 Intravenous fluids to maintain blood pressure
 Full blood count, coagulation screen, chemistry
 Repeat Blood group pre and post samples
 Return blood unit to blood bank
 Blood cultures
 Intensive care, treatment DIC, dialysis

14

what does DHTR stand for

- Delayed haemolytic transfusion reaction

15

What is a Delayed haemolytic transfusion reaction due to

Due to red cell Ab’s - IgG
 Rh system/ Kell/ Fya/ Jkb etc

16

What are the signs of a delayed haemolytic transfusion reaction

- Failure of haemoglobin to rise
- jaundice

17

what test is positive in a delayed haemolytic transfusion reaction

DirectAntiglobulinTest(DAT)positive

18

How common are red cell antibodies which lead to delayed haemolytic transfusion reaction

 ~1% of transfused patients
 Much higher rates allo-immunisation in patients with Sickle Cell Disease ~ 20%
 give extended Rh and matched blood

19

What does FNHTR stand for

Febrile non-haemolytic transfusion reactions (white cell problem)

20

What happens in a Febrile non-haemolytic transfusion reactions

 Fever - rise in temp > 1°C ± shakes/ rigors
 ± increase in pulse

21

What has caused less Febrile non-haemolytic transfusion reactions

- Leucodepletion of blood and platelets - the filtering out of white blood cells

22

what allergic reactions can occur due to a blood transfusion

- urticarial rash
- anaphylaxis

23

describe a urtical rash experienced due to a blood transfusion

- often not severe
- hypersensitivity to a random plasma protein

24

describe anaphylaxis experienced due to a blood transfusion

Severe, life-threatening reaction soon after transfusion started
 Wheeze/ asthma, increase pulse, increase BP (shock)
 Laryngeal oedema/ facial oedema
 Uncommonly may be related to IgA deficiency

25

Name two types of pulmonary complications due to blood transfusion

- Transfusion associated circulatory overload (TACO)
- Transfusion related acute lung injury (TRALI)

26

what is the difference between TACO and TRALI

TACO
- PA pressure is greater than 18mmHg
- improves with a diuretic

TRALI
- PA pressure is equal to or less than 18mmHg
- does not improve with diuretic

27

What patients are at risk of TACO

- elderly patients
- existing heart disease
- very small patients given large volume of transfusion

28

describe what causes TRALI

- transfused anti- leucocyte antibodies in donor plasma which interact with the patients white blood cells
- this leads to bilateral pulmonary infiltrate

29

How do you manage TRALI

- Supportive management
- Ventilation

30

What does TACO stand for

Transfusion associated circulatory overload (TACO)