Transfusion reactions

What are some common errors associated with transfustion reactions?

• patient misidentification

• sample error

• wrong blood issued

• transcription error

• blood administrator error

• technical error

• blood storage error 

What percentage of transfusion reactions are non-hemolytic?

96%

What is a febrile reaction?

When a rise in temperature of >1 degree occurs

What percentage of transfusion reactions are febrile?

1%

What causes febrile reactions?

Anti-wbc antibodies

What are the symptoms of febrile reactions?

• fever

• chills 

What is the cause of an allergic transfusion reaction?

Donor plasma 

What steps are taken after a febrile reaction?

Use of leukocyte poor products

What percentage of transfusion reactions are allergic?

20%

What are the symptoms of an allergic transfusion reaction?

• itching

• hives

• edema 

What precautions are taken after an allergic transfustion reaction?

Uses of plasma free products 

What causes an anaphylactic transfusion reaction?

An allo anti IgA antibody

What are the symptoms of an anaphylactic transfusion reaction?

• mild allergic reaction

• shock

• death 

What are the future considerations after an anaphylactic reaction?

Plasma free products, donors lacking IgA

What is TACO?

Transfusion associated circulatory overload

What are the symptoms of TACO?

• chest pains

• dyspnea

• cough

• heart failure 

What are the future considerations after TACO?

Infuse more slowly

What is TRALI?

Transfusion Related Acute lung injury

What is the cause of TRALI?

Anti WBC antibodies, damage lung tissue 

What are the symptoms of TRALI?

• chills

• cough

• fever

• respiratory failure

What causes graft vs host disease?

Donor T cells attack immunocompromised patient

What are the symptoms of graft vs host?

• pancytopenia 

• fever

• abnormal liver fuction 

What are the future considerations of graft vs host?

Irradiated products

What are the transfusion transmitted diseases?

Hepatitis, HIV, HTLV, West Nile virus, CMV, EBV, Malaria, Babesiosis, Chagas, Toxoplasma, Rocky mountain spotted fever, syphilis 

What is transfusion induced hemosiderosis?

Iron overload

What is the cause of post transfusion purpura?

• Platelet allo antibodies

• depletion of plt and coag factors 

What are some complications associated with massive transfusion?

• citrate toxicity

• hypothermia

• dilutional thrombocytopenia

What is one other non-hemolytic cause of transfusion reactions?

alloimmunization 

What percentage of transfusion reactions are hemolytic?

4%

What are the two categories of hemolytic transfusion reactions?

• intravascular vs extravascular

• immediate vs delayed  

What causes immediate intravascular hemolysis?

• IgM-complement activating Ab

• IgG ab

• ABO mix up

When do the symptoms of immediate intravascular hemolysis typically start?

Within minutes to 2 hours 

What are the symptoms of immediate intravascular hemolysis?

• fever, chills

• renal shutdown

• DIC

• hemoglobinemia 

What is the mortality rate of immediate intravascular hemolysis?

10%

What is the treatment of immediate intravascular hemolysis?

Supportive 

What is immediate extravascular hemolysis?

Like intravascular without hemoglobinemia

What causes delayed extravascular hemolysis?

Anamnestic response or ab production

What antibodies can cause delayed extrabascular hemolysis?

• Rh antibodies

• anti Jka

• anti K

• anti Fya 

What are the symptoms of a delayed extravascular hemolysis reaction?

• decreased hgb and hct

• fever 

• chills

• jaundice 

How long does it take for the symptoms a delayed extravascular hemolytic reaction to occur?

3-7 days post transfusion

What can cause physical damage to transfused cells?

• heat damage from blood warmers or during storage

• physical damage from pumps or heart valves 

What are some common organisms that contaminate blood bags?

• yersinia enterocolitica

• pseudomonas 

• E. coli 

What are the symptoms of microbe contamination of blood products?

• rapid onset

• fever, chills, DIC, shock, death 

What are the patient care responsibilities of a suspected transfusion reaction?

• take vital signs

• stop the transfusion

• keep IV line open with saline

• notify physician and transfusion service 

• perform bedside clerical check

• document information 

• treat patient with antihistamines

• continue transfusion or send unit and appropriate samples to lab  

What are the lab responsibilities after a transfusion reaction?

• perform clerical check

• observe pre and post samples for hemolysis

• serum/plasma hemoglobin

• gram stain/culture

• perform DAT

If the DAT on the post sample is positive what is done?

DAT on the pre sample 

When is an extended evaluation needed?

• discrepancy in clerical check

• post DAT pos and pre DAT negative or weaker

• visual hemolysis

• post serum/plasma hgb 20 mg/dl greater than pre serum/plasma hgb 

What is done on an extended evaluation?

• ABO/Rh, IAT and crossmatch on both the pre and post samples

• ABO/Rh on returned unit and pre lab segment, Ag if an ab identified  

What additional tests are ordered on an extended evaluation?

• urine hgb with microscopic if positive 

• serum bilirubin 

• plasma hgb 

• haptoglobin 

• cultures

What documentation is required for transfusion reactions?

• notification of physician and blood bank director

• reporting of reactions to accrediting agencies

• fatalities-FDA and Center for biologic evaluation and research