Blood Banking - Lecture - 15 - Transfusion Reactions / Adverse Effects of Blood Transfusion - Part 2 - no

Delayed hemolytic transfusion reaction

Defined as:

--DAT (+) 24 hrs to 28 days after transfusion

--(+) Eluate or newly identified alloantibody in the plasma/serum

--Evidence of hemolysis

Hemoglobin

Evidence of hemolysis in Delayed hemolytic transfusion reaction

It inadequately rises after transfusion

Rapidly drops to the pretransfusion level

Spherocytes

Evidence of hemolysis in Delayed hemolytic transfusion reaction

RBC morphology on PBS examination

T

T/F

Biochemical evidence of hemolysis is considered evidence of hemolysis in Delayed hemolytic transfusion reaction

7-10 days

Most Delayed hemolytic transfusion reaction take how many days to appear post-transfusions

Delayed serologic transfusion reaction

Defined as the same serologic findings as DHTR but without evidence of hemolysis

Transfusion-related acute lung injury

Rare event associated with acute respiratory distress

Transfusion-related acute lung injury

Leading cause of mortality due to adverse reactions to transfusion

Transfusion-related acute lung injury

Defined by NHSN Hemovigilance as: the absence of evidence of acute lung injury (ALI) prior to transfusion

Transfusion-related acute lung injury

Defined by NHSN Hemovigilance as: Acute lung injury during or within 6 hours after transfusion

Transfusion-related acute lung injury

Defined by NHSN Hemovigilance as: Evidence of hypoxemia by blood gas or oxygen saturation testing

Transfusion-related acute lung injury

Defined by NHSN Hemovigilance as: Radiographic evidence of bilateral pulmonary edema

Transfusion-related acute lung injury

Defined by NHSN Hemovigilance as: Exclusion of circulatory overload and other causes of pulmonary edema

National Healthcare Safety Network

NHSN meaning

Possible Transfusion-related acute lung injury

Designated when the criteria are present, but another cause of ALI is also identified

Ex. Patient transfused → Develops dyspnea + hypoxemia + bilateral infiltrates within 6 hours, but also has sepsis

Sepsis

It can be another cause of acute lung injury

Delayed Transfusion-related acute lung injury

Refers to when criteria for TRALI are present, but the onset is 6-72 hours after transfusion

50-100 times

Transfusion-related acute lung injury is how many times more common in critically ill and surgical patients

Transient leukopenia and thrombocytopenia

This is seen in 25% of Transfusion-related acute lung injury patients

Mechanical ventilation, Cardiac surgery requiring cardiopulmonary bypass, Patients receiving multiple transfusions, such as hematological malignancies with intensive chemotherapy, liver failure with active bleeding, Massive transfusion, Positive fluid balance

Patient Risk Factors for TRALI

Pneumonia, Aspiration, Inhalation of toxic gas, Infarct, Severe asthma

Primary Pulmonary Causes of Acute Lung Injury in Critically Ill Patients

Sepsis, Shock, Trauma, Burns, Pancreatitis, Drug overdose

Secondary Causes of Acute Lung Injury in Critically Ill Patients Due to Systemic Diseases

Antibody-mediated

Majority of Transfusion-related acute lung injury cases are Antibody-mediated or Non-antibody-mediated?

Anti-HLA Class I, Anti-human neutrophil Antigen

Antibody-mediated causes of Transfusion-related acute lung injury

Anti-HLA Class I

Antibody-mediated cause of Transfusion-related acute lung injury

More frequent

Anti-human neutrophil Antigen

Antibody-mediated cause of Transfusion-related acute lung injury

Direct binding of antibodies to neutrophils

Anti-HLA Class I

Antibody-mediated cause of Transfusion-related acute lung injury

Indirect binding of antibodies to endothelial cells and monocytes, leading to subsequent neutrophil activation

HNA-1, HNA-2, HNA-3a

Human neutrophil antigens associated with the most severe fatal reactions

Antibody-mediated

Cause of Transfusion-related acute lung injury

Neutrophil activation → Endothelial damage → Capillary leak → Pulmonary edema

Neutrophil activation

The goal in starting the development of TRALI

Non-antibody-mediated

Cause of Transfusion-related acute lung injury

Caused by certain mediators in the transfused products that activate endothelial cells in the pulmonary microcirculation that induces neutrophil activation, capillary leakage, and pulmonary edema.

Bioactive lipids

Non-antibody-mediated Transfusion-related acute lung injury

Mediators implicated in the process are ___ derived from cell membranes and soluble CD40, a proinflammatory mediator produced by platelets

Two-hit model

Model that explains the development of TRALI