non-infectious complications

what are some of the general causes?

• antibodies to red cell antigens

• antibodies to leukocyte or platelet antigens or plasma proteins

• unavoidable reactions

• technical errors

• clerical errors/human error/ management system errors

extravascular hemolysis

• IgG antibodies

• doesn’t usually bind complement

• slower destruction

• RBCs are phagocytosed and destroyed by RE cells

signs of extravascular hemolysis

• fever

• decreasing hemoglobin

• mild jaundice

• hemoglobin doesnt rise as expected

• possible to be asymptomatic

lab signs of extravascular hemolysis

a positive DAT

increased serum bilirubin

unexpected antibody now detected

intravascular hemolysis

• red cell destroyed in the blood stream

• caused by antigen-antibody complexes that bind complement

• hemoglobin is released

• usually seen with hemoglobinuria

• can also cause coagulation cascade or neuroendocrine response

symptoms of acute hemolytic reactions

• fever

• chills

• pain at site of infusion, chest, or back

• hypotension/shock

• nausea

• facial flushing

• shock

• feeling of impending doom

• hemoglobinuria

• DIC

• oliguria

• anuria

lab signs of an acute hemolytic reaction

• hemoglobinemia

• hemoglobuniuria

• serm bilirubin

• positive DAT or weakly positive or negative (donor cells could be lysed)

treatment of acute hemolytic reactions

• stop transfusion immediately but keep IV open

• maintain blood pressure

• maintain urine flow

causes of acute hemolytic reactions

• clerical and human error leading to ABO mismatches

delayed hemolytic reactions

• due to a secondary immune response

• extravascular hemolysis

• usually happens 3-14 days after transfusion

Febrile Nonhemolytic reaction (FNH)

rise in 1 degree celsius during or after a transfusion with no other apparent cause

cause:

• cytokines from WBCs in the donor unit

• antibody to WBCs, platelet antigens, or people who have been transfused multiple times

symptoms of FNH

• fever

• chills

• patient discomfort

• anxiety

treatment for FNH

• rule out HTR or bacterial contamination

• stop transfusion

• antipyretics to bring down fever

• can be prevented with leukoreduction

allergic reactions treatment

• treat with antihistamines (mild)

• can restart transfusion if symptoms resolve

• for anaplyaxis have to rule out hemolysis and use epinephrine and fluids

allergic reactions

receiving plasma

• cause: antibodies to plasma proteins in donor blood

• usually mild

• some occur in minutes and rash/hive/itching

• can affect respiratory tract, GI tract, and the circulatory system

• can also cause anaphylaxis

• prevent: don’t give plasma to IgA deficient and wash red cells

cause of TRALI

antibodies to HLA, granulocyte antigens

• passive transfer of donor antibodies

• can lead to pulmonary edema

• cytokines are released

• neutrophils mediate endothelial damage

• usually comes from female donors with multiple pregnancies or donors with multiple transfusions

treatment of TRALI

• rule out hemolysis

• stop transfusion

• give O2

prevention of TRALI

• test plasma for HLA antibodies

• screenings

• stop collection from female donors (not really)

cause of TACO

• sudden increase in blood volume not tolerated well by compromised cardiac/pulmonary patients

treatment for TACO

• stop transfusions

• diuretics

• give O2

• therapeutic phlebotomy

prevention of TACO

dont give blood too fast

cause of GVHD

• donor lymphs react and immune respond to recipient

• immunocompetent lymphs engraft and multiply

• greatest risks are for immunocompromised, intrauterine transfusions, and blood relatives

prevention for GVHD

• leukoreduction

• irradiate to stop lymph proliferation

3 steps that need to be taken if a HTR is suspected

1. clerical check (ID errors)

2. check for hemolysis (examine post reaction sample and compare to pre sample)

3. check for incompatibility (DAT on post specimen and compare to pre sample)

additional testing if HTR is suspected

• ABO/Rh on pre and post

• repeat crossmatches for pre and post

• repeat ab screen on pre, post, and donor

• culture on donor

• check for non-immune hemolysis

• post urine hemoglobin

• post serum bilirubin

complications with massive transfusions

• citrate toxicity from anticoagulant (give calcium)

• hypothermia (reduce rate and use blood warmer)

• hypokalemia/hyperkalemia (use fresher units for infants)

• coagulopathy

• iron overlaod (especially for chronic transfusion recipients; use iron chelators)

alloimmunization risks

RBC: 1%/unit; try identical phenotypic match

WBC: 10%/unit

development of antibodies to HLA, granulocyte, and platelet antigens

non-immune hemolysis

• rare

• overheat

• seen with a negative DAT and no immune response

• hung something with the IV

• contaminated blood (yersinia)

• stop transfusion and rule out causes

symptoms of TRALI

• acute respiratory distress

• bilateral pulmonary edema

• severe hypoxemia