adverse rxns to blood tfxns

acute

transfustion rxn occurs within 24 hrs of transfustion

delayed

transfusion rxn occurs 24 hrs to months after transfusion

acute hemolytic transfusion rxn (AHTR)

-rapid RBC destruction

-ABO incompatibility

-due to clerical errors

-fever, chills, hypotension/shock, flank/chest/back pain, hemoglobinuria

-intravasc (IgM) or extravasc (IgG)

-dose dependent

-variable DAT (extent of hemolysis)

-coag system activation (DIC)

IgM, schists

AHTR occurs intravascularly is IgM/IgG mediated, binds complement, and schists/spherocytes are seen

IgG, spherocytes

AHTR occurs extravascularly (spleen, liver) is IgM/IgG mediated and schists/spherocytes are seen

no

yes/no

a negative DAT means that an AHTR is not occurring

delayed hemolytic transfusion rxn (DHTR)

-hemolysis as anamnestic response

-fever, mild jaundice, hemoglobinuria, AKI (rare)

-dec Hct post-tfxn

-pos mf DAT

-Ab screen now pos

-spherocytes

dec

Hct is inc/dec post transfustion in DHTR

febrile non hemolytic transfusion rxn (FNHTR)

-most freq reported rxn

->1 C (1.8 F) rise in temp above 37 C within 4 hrs of tfxn

-neg DAT, no hemolysis

-due to cytokines and anti-leukocyte Ab in blood products

-treat: give Advil/Tylenol before next tfxn

-prevent: leukocyte reduced blood

>1, 4

a rise in temp by x C within x hrs of tfxn is indicative of febrile NHTR

neg

DAT and hemolysis are pos/neg with febrile NHTR

type I

hypersensitivity type causes allergic transfusion rxn

plasma

blood component transfused that can cause allergic transfusion rxn

yes

yes/no

if an allergic tfxn rxn occurs, stop the tfxn, treat the patient with benadryl, and if the hives go away, you can restart the tfxn

allergic transfusion rxns (ATR)

-type I hypersensitivity rxn (allergen in product and pt Ab)

-common with plasma products

-mild (hives) to severe (swelling)

-can restart tfxn if no hives after benadryl and no fever

-DAT neg, no hemolysis

anaphylaxis

-ATR of pts with IgA deficiency AND presence of anti-IgA Ab

-cannot receive plasma products

-receive washed products (RBCs, PLTs)

anaphylatoxins

-released upon immune complex formation and complement fixation

-activates mast cells and basophils

transfustion related acute lung injury (TRALI)

-develops within 6 hrs of tfxn

-can be fatal

-hypotension

-diffuse bilateral infiltrates on X ray

-due to anti-HLA or gran Ab in donor

-treat: resp support

-prevent: avoid use of plasma components from women who have been pregnant or who have HLA Ab

hypo

a defining symptom of TRALI is hypo/hyper -tension

donor

TRALI occurs due to anti-HLA or gran Ab in pt/donor

plasma

what products women who have been pregnant (multiparous) or who have HLA Ab are exempt from donating (TRALI prevention)

transfusion associated circulatory overload (TACO)

-tfxn rxn due to infusion vol overload

-can be fatal

-seen 1-2 hrs post tfxn

-elderly, infants, CHF, end stage renal disease

-hypertension

-treat: resp support

-prevent: avoid large vol plasma, transfuse slowly and only what need when need, only RBC prod

hyper

a defining symptom of TACO is hypo/hyper -tension

TA GVHD

-rare, highly lethal

-due to viable lymphs in blod prod

-3-30 days post-tfxn (fever, rash, pancytopenia)

-destroys pt bone marrow (marrow aplasia), hemmorhage, 90% mortality

-test: HLA typing

-treat: palliative

-prevent: irradiation

septic

-rare

-due to bacterial contam

-asympt bacteremic donor, bact survives storage conditions

-PLTs and skin contam, RBCs

-rapid symptom onset: fever, chills, hypotension, shock

-hgburia/emia, neg DAT, pos gram stain and culture

-treat: bs antibiotics

-prevent: proper collection, storage, and handling of products (always check visually multiple times for discoloration, clots, cloudiness, hemolysis)

neg

DAT is pos/neg with septic tfxn rxn

PLTs

-product with bacterial contam by skin flora

-S. epi, S. aureus, C. acnes

RBCs

-product with bacterial contam by bact that can survive storage conditions

-Y. enterocolitica, E. coli, Enterobacter, Pseudomonas, Serratia

post transfusion purpura (PTP)

-marked thrombocytopenia 5-12 days post tfxn with unexplained purpuric rash, bruising, mucosal bleeding

-PLA1- pt exposed to PLT1+ PLTs causes Ab that destroy all PLTs due to passive reabs of complex or Ab onto PLTs

-multiparous women at risk

-treat: self lim, IVIg, steroids, no tfxns

iron overload

-excess systemic iron

-deposits in organs (liver, heart, pancreas, other endocrine)

-inc risk cirrhosis, heart failure, diabetes

-typical in pts receiving chronic tfxns (B thalass, SCD, MDS)

-sympt with organ damage

-treat: therapeutic phleb or iron chelation drugs

delayed serologic (DSTR)

-no clinical signs or sympt of DHTR

-new Ab ID’d in blood bank

-use Ag neg blood in future tfxns

transfusion associated dyspnea (TAD)

-one symptom occurring alone or predom in allergic, TACO, TRALI

-diagnosed when occurs within 24 hrs of tfxn

-no clear cause, just can’t breathe

hypotensive transfusion rxn (hypo TR)

-low BP <1 hr after tfxn

-no other adverse rxns present

2-3 wks

“window period” between infection and detection of Ab to infectious disease

rare

infectious complications due to tfxns are common/rare

both

a pre/post transfusion DAT is needed for pt receiving tfxn

elution

additional testing done if DAT is pos

intra

intra/extra vascular hemolysis is indicated by pink, red, coca cola color of plasma

FDA (7)

where tfxn-related fatalities are reported ASAP and time to write official report (days)

AH, FNH, septic, TRALI

acute febrile TRs

DH, TA GVHD

delayed febrile TRs

TACO, TAD, allergic, hypo

acute non-febrile TRs

serologic, PTP, iron overload

delayed non-febrile TRs