CLS 306 (BB) - Lecture 10: Adverse Effects of Transfusion

• Hemolytic

• Febrile

• Allergic

• Transfusion-Related Acute Lung Injury

Immediate immunologic transfusion reactions (4)

• Bacterial Contamination

• Transfusion-Associated Circulatory Overload

Immediate Non-Immune Respones (2)

• Hemolytic

• Graft vs Host Disease

• Cytomegalovirus

Delayed immunologic transfusion reactions (3)

• Iron Overload

• Disease Transmission

Delayed Non-Immunologic Rxn (2)

1. STOP transfusion

2. OPEN IV line for med admin

3. MONITOR pt

4. TRANSFUSION Rxn Investigation

5. RETURN Blood / blood comp. back to blood bank when completed

Common procedure taken for a Transfusion Reaction (5)

• Heat along infusion arm

• Feeling of Doom

• Tachycardia/Dyspnea

• Drop in BP

• Hemolysis/DIC

• Low Back + Chest Pain

• Hematuria

• Kidney failure

Acute Hemolytic Transfusion Rxn / AHTR Symptoms (8)

• ABO Incompatibility

• As little as 5-20 mL of RBC transfused

Causes of Acute HTR (2)

• Misidentification

• Staff Hurry + Wrong PT transfused

• PT relocated + Wrong PT transfused

• Mass casualty + Poorly ID pt

Human Causes of HTR (4)

• Diuretics

• Analgesics

• Pressors for hypotension

• Hemostatic infusion if bleeding

Acute HTR Treatment (4)

• Proper Identification

• Proper Triage of Mass-Cas.

• Properly Label Specimen

• ABO Match to pt / Acc. Testing

• Accurate Labeling of pt Unit

Acute HTR Prevention (5)

• Wrong blood in tube

• Lack of electronic systems for pt ID

• Failure to perform final bedside check

• Manual laboratory processes

Most Common Causes for Transfusion Fatility (4)

• Fever (at least 1°C or 1.8°F)

• Chills

• Headache

• Anxiety

• Tachycardia

Febrile, Non-Hemolytic Transfusion Rxn Symptoms (5)

• WBCs or Platelets in Blood / Blood Components

• Antipyretic med (tylenol)

• Transfuse leuko-reduced blood / blood components

Febrile, nonhemolytic Rxn (common cause, treatment, prevention)

• Urticaria / Rash

• Itching / Pruritis

• Flushing

Allergic Rxn Basic Symptoms (3)

• Dyspnea

• Throat Swelling / Tongue

• Hypotension

• Cardiac Arrhythmia

Advanced Allergy Signs (4)

• Reactable substance in recipient’s blood

• Plasma proteins for IgA deficient patients

Allergic Rxn Common Causes (2)

• Mild: antihistamines, slower transfusion rate

• Severe: Diphenhydramines or epinephrine

Treatment for mild and severe allergic transfusion reaction

• Antihistamine (benadryl) before transfusion

• IgA def blood → IgA def pt

• Adsol to replace residual plasma in RBCs

• InterSol for platelet products in PLTs

Allergic Prevention (4)

• Within during or 6 hours AFTER transfusion

• Respitaroy Distress

• Dyspnea / Tachypnea

• Hypotension

• Pulmonary Edema

TRALI Symptoms (5)

• HLA Antibodies in blood / blood products - usually multiparous females

• Treatment

  • O2 support

  • Intubation = mechanical ventilatory support

  • Improvement w/in 48 hours

TRALI Cause and Treatment (3)

• Blood products from males

• Blood products form females tested for HLA antibodies

TRALI Prevention (2)

• Fever

• Rigor

• Shivering

• Hypotension / Shock

• Tachycardia

• Dyspnea

Bacterial Contam. Symptoms (6)

High mortality

Although uncommon, bacterial contamination can have a rapid onset and (——) in recipients

• Febrile reactions

• Septic/endotoxic shock

The presence of bacteria in transfused blood may lead either to (——) in the recipient due to pyrogens or serious manifestations of (——)

• Yersinia enterocolitica

• Pseudomonas fluorescens

• Serratia liquefaciens

Common causes of bacterial contamination in packed RBCs (3)

• Staphylococcus epidermidis

• Staphylococcus aureus

• Bacillus cereus

• Propionibacterium sp.

• Micrococcus sp.

• Group C Streptococcus

Common cause of bacterial contamination in PLTs (6)

• IV antibiotic therapy

Treatment of bacterial contamination transfusion

• Use aseptic technique when collecting donor blood

• Use sterile docking technique when transferring product

• Use bacterial tests prior to transfusion

• Use pathogen reduction technology

Bacterial contamination prevention (4)

• Within 12 hours following transfusion

• Respiratory distress / hypoxemia

• dyspnea

• hypertesnion

• jugar vein distention

• pulmonary edema

Transfusion-Associated Circulatory Overload Symptoms (6)

Fluid overload from blood transfusion - either by single or multiple units

TACO common cause

• Treatment

  • PT in upright position

  • Administer O2 when indicated

  • Diuretics when indicated

• Prevention: reduce amt of fluid intake at one time

TACO - Treatment (3) & Prevention

Undetected RBC antibody (usually anti-JkA)

DHTR common cause

• Hb/HCT drop

• 7-10 days (anti-Jka = 14 days)

• Extravascular

With DHTR, patient is usually asymptomatic with only (——), and reaction occurs within (——) days. Hemolysis is usually (——)

• Smoky-grey serum if ant-JkA

• Positive DAT (can be weak)

• Weak reacting Ab with complement binding

Lab Evidence - DHTR (3)

• Indirect hyperbilirubinemia

• Fever

• Maliase

• Spherocytes

DHTR Symptoms (3) and Hematology

1. Unit returned to BB

2. Clerical Information (Discrepancies

3. Patient Testing (inspect hemolysis, DAT, ABO/Rh, ABS)

4. Unit (ABO/Rh)

Transfusion Rxn Worksheet (4)

• Immunosuppressed PTs

• High Fatility

• Donor-T cells attack self

• 2 days - 6 weeks after transfusion

Transfusion-Associated GVHD - Demographic - Mortality - Mechanism - Timeframe (4)

• Rash + Fever

• Diarrhea

• Pancytopenia

• Liver Dysfunction / Jaundice

TA-GVHD Symptoms (4)

1. Conditioning regimen damage and activates host tissue to secrete cytokines → upregulate MHC Ag

2. Donor T Cell activated

3. Multiple inflammatory cascades

   1. (Th1 CD4 → TNF⍺, IL-1 → apoptosis

3 Phases of TA-GVHD

• Prevention

  • Irradiated Blood / Blood Comp

  • HLA-matched organ donor

• Treatment: Admin of anti-rejection medication

TA-GVHD Prevention (2) and Treatment

• Caused by herpes

• Death in neonates

• Death in allogenic BONE MARROW transplants

• Found in WBCs

Cytomegalovirus Infection (cause, important population (2), location)

• Adults: Asymptomatic or mono like symptoms + leukopenia + gastroenteritis + pneumia

• Infants: Rash - Jaundice - Enlarged Liver / Spleen - Pneumonia / Seizures

CMV Symptoms in adults (4) and infants (4)

• Transfusion of CMV pos blood where donor was NOT tested

• 20- 60 days after transfusion

CMV - Cause + Manifestation

• Treatment: Antiviral oral / IV therapy

• Prevention:

  • Sereologic test for CMV

  • Use of leuko reduced blood products

CMV Treatment and prevention (2)

• Delayed immune complication

• Thrombocytopenic Purpura

• Bleeding from mucous membranes

Post-Transfusion Purpura Symptoms (3)

• 5-10 days post-transfusion

• Cause: PLT Ab (i.e., anti-HPA-1a)

• Treatment: IV Ig

(Symptoms like febrile reaction)

Post transfusion purpura (manifestation, cause, treatment)

Iron Overload (Hemosiderosis)

Condition typically seen in chronically-transfused patients (i.e., sickle cell, thalassemia, etc.)

MRI

(Hemosiderosis) Liver and cardiac iron concentration noted with (——); Fe(2+) lab test elevated

• Reduce frequency of transfusion by erythropoietin

• Infusion of iron-chelating agents

Treatment of hemosiderosis (2)

• Chronic fatigue

• Frequent infections

• Nerve system disorders

• Joint pain

• Hair / skin pigment changes

Iron Overload / Hemosiderosis Symptoms (5)

• Shortness of breath

• coughing

• hypotension

• acute cyanosis

Air Embolus Signs (4)

• Lay patient on left for mild

• Hyperbaric chamber for severe cases

Air Embolus Treatment (2)

• Symptoms

  • Tingling sensation / Paresthesia

  • Cardiac arrhythmia

  • Tetany

• Treatment: Infusion of calcium supplements

Hypocalcemia - Symptoms (3) and Treatment

• Symptoms

  • Cold / Shivering

  • Cardiac arrthymia

• Treatment: Blood warmer

Hypothermia Symptoms (2) and Treatment

• Herpes Simplex Virus (HSV1 and HSV2)

• Group B Streptococcus

• Cytomegalovirus

Worrisome diseases for blood transfusions (3)