immunohematology - transfusion reactions

adverse transfusion reaction

an undesirable response or effect in a patient temporarily associated with the administration of blood or blood component

acute hemolytic transfusion reactions (AHTRS)

rapid destruction of RBCs within 24 hours of transfusion, sings range in severity from fever to death, usually due to ABO incompatibility

fever

most common symptom of acute hemolytic reactions

acute intravascular hemolytic reactions

fatal in 1 in 1.8 million transfusions, preformed antibody binds to transfused red cells, complement fixation, C5b-9 MAC, rapid hemolysis: cytokines, chemokines, complement fragments all involved

acute hemolytic transfusion reactions (AHTRS)

antibody binds to incompatible RBC antigens, complement is activated (intravascular hemolysis), phagocytes are activated and release cytokines, coagulation is activated (DIC), shock and renal failure occur

delayed hemolytic reactions

symptoms usually appear after 24 hours from the time of transfusion, less severe than AHR, usually due to IgG antibodies formed from prior exposure to RBCs through previous transfusion or pregnancy, antibodies may be undetected during pretransfusion testing

nonimmune hemolytic anemia

RBC destruction when antibodies are not implicated

febrile nonhemolytic reactions

classically related to antibodies in recipient directed against HLA and/or leukocyte specific antigens on donor white cells and platelets; cytokines released from leukocytes that can accumulate during blood storage

leukoreduction

_____ decreased frequency of febrile nonhemolytic reactions

febrile nonhemolytic reactions

fever, shaking chills, headache, dyspnea, vomiting, decreased oxygen saturations

febrile nonhemolytic reactions

not life threatening, do not continue transfusing

tylenol, meperidine

treatment for FTRs

leukocyte reduced red cells and platelets

need at least 5 × 10^6 residual WBCs in at least 95% of units sampled

leukocyte reduced red cells and platelets

benefits: decreases FTRs, reduce HLA alloimmunization that can cause platelet refractoriness, decreased DMV transmission

IgE

allergic reactions are _____ mediated to plasma proteins

fever

allergic reactions cause pruritis and urticaria without _____

antihisamines

prevention and treatment of allergic reactions

allergic reaction

can continue transfusion only if patient has rash that resolves with treatment or waiting

no

do leukoreduction and irradiation prevent allergic reactions?

allergic reaction

IgE reacts with plasma proteins

anaphylactic reactions

recipient forms antibodies to IgA

anaphylactic reactions

in IgA deficient subjects with IgA antibodies, symptoms are respiratory distress, bronchospasm, and hypotension

transfusion related acute lung injury (TRALI)

most common transfusion related fatality in US, most frequently associated with FFP or platelet transfusions

transfusion related acute lung injury (TRALI)

symptoms are tachypnea, cyanosis, dyspnea, fever, hypoxemia, and intubation

transfusion related acute lung injury (TRALI)

treatment is aggressive respiratory support, no diuretics, fatal in about 15% of cases

transfusion associated graft vs host disease (TA-GVHD)

rare but almost always fatal due to immunosuppression, occurs 8-10 days post transfusion, marked pancytopenia, fever, rash, mucositis, diarrhea, hepatitis and acute liver failure

transfusion associated graft vs host disease (TA-GVHD)

recipients share a haplotype with an HLA homozygous donor, which  allows donor lymphocytes to proliferate and attack recipient, recipient immune system cannot inactivate donor lymphocyte before colonization

transfusion associated graft vs host disease (TA-GVHD)

prevented by irradiating cellular blood products, inactivates T lymphocytes in transfused lymphocyte from attacking recipient, 100% effective in preventing this

transfusion related sepsis

caused by bacteria in blood products from donor or from the collection process, more common in platelets than RBCs; can cause fatal septicemia with rapid onset of chills/fever, vomiting, profound hypotension, shock

transfusion related sepsis

evaluate by culturing both patient and blood units, treat with antibiotics, fluids and vasopressors

apheresis platelets and platelet concentrations

tested for bacteria by culturing the products

transfusion associated circulatory overload (TACO)

patient’s cardiopulmonary system exceeds its volume capacity, symptoms and signs of congestive heart failure

transfusion associated circulatory overload (TACO)

treated with oxygen therapy and diuretics, candidates are susceptible to circulatory overload should receive RBC units

transfusion associated circulatory overload (TACO)

symptoms are cough, dyspnea, hypertension, tachycardia and distended neck vein

hemosiderosis

accumulation of excess iron in macrophages in tissues, present with weakness, bloody cough, and skin bronzing; usually occurs in patients underoging long term transfusions, iron intake exceeds daily iron excretion

hemosiderosis

prevention involves iron chelation

citrate toxicity

occurs when large quantities of citrated blood products are transfused, symptoms primarily related to hypocalcemia

citrate toxicity

may have adverse affects in those receiving large volumes of blood, patients with impaired liver function, preterm infants with hepatic or renal insufficiency

citrate toxicity

prevent by removing plasma that may contain citrate, inject calcium chloride or calcium gluconate

posttransfusion purpura

women negative for platelet antigen P1A1 are sensitized through multiple pregnancies (produce anti-P1A1 antibodies)

posttransfusion purpura

platelet count decreases 5-12 days after transfusion, rare but can be severe/life threatening

posttransfusion purpura

treat with plasmapheresis, exchange transfusion, steroids, and intravenous IgG