CLS 306 BB lecture 10

What are the two categories of risks associated with transfusion?

• Immediate: Occur during or shortly after transfusion

• Delayed: Occur after completion of transfusion (post-transfusion)

How are immediate transfusion reactions classified?

• Immunologic

• Non-immunologic

What are immediate immunologic transfusion reactions?

• Acute hemolytic reaction

• Febrile reaction

• Allergic reaction

• TRALI (Transfusion-Related Acute Lung Injury)

What are immediate non-immunologic transfusion reactions?

• Bacterial contamination

• TACO (Transfusion-Associated Circulatory Overload)

What are delayed immunologic transfusion reactions?

• Delayed hemolytic reaction

• Graft-vs-Host Disease (GVHD)

• Cytomegalovirus (CMV)

What are delayed non-immunologic transfusion reactions?

• Iron overload

• Disease transmission

What are the signs and symptoms of an acute hemolytic transfusion reaction (AHTR)?

• heat

• anxiety, feeling of doom

• tachycardia, dyspnea

• severe hypotension, shock, drastic drop in BP

• hemolysis, DIC

• back/chest pain

• hematuria (bloody urine)

• kidney failure

• DEATH

What is the most common cause of an acute hemolytic transfusion reaction?

ABO incompatibility — can occur with as little as 5–20 mL of transfused RBCs

How is an acute hemolytic transfusion reaction treated?

• Diuretics (protect kidneys, makes you pee/flush stuff out)

• Analgesics (pain pills)

• Pressors for hypotension (increase BP)

• Hemostatic components if bleeding is present

How common are transfusion-related deaths, and what is the most common cause?

• rare

• 3rd leading cause of transfusion-related mortality in the U.S.

• Most common cause: Wrong Blood in Tube (WBIT)

  • lack of electronic systems for patient ID

  • failure to perform bedside check

  • manual lab processes

What are the signs and symptoms of a febrile (non-hemolytic) transfusion reaction?

• Fever

• Chills

• Headache

• Anxiety

• Tachycardia

What are the common cause, treatment, and prevention of a febrile (non-hemolytic) transfusion reaction?

• Common cause: WBCs and platelets present in blood/blood components

• Treatment: Antipyretics (usually acetaminophen/Tylenol)

• Prevention: Use leuko-reduced blood/ blood components

What are the common signs and symptoms of an allergic transfusion reaction?

• Urticaria (hives) / sudden rash

  • Neck

  • Arms

  • Chest / back

• Itching (pruritus)

• Flushing

What are advanced (severe) signs and symptoms of an allergic transfusion reaction?

• Dyspnea

• Throat swelling / tongue swelling

• Hypotension

• Cardiac arrhythmia

What is the common cause of an allergic transfusion reaction?

• Reaction to something in the donor’s blood

• plasma proteins (IgA Def - rare genetic condition): severe, life threatening

How is a mild allergic transfusion reaction treated?

• Antihistamines (e.g., Benadryl)

• Slow the transfusion rate

How is a severe allergic transfusion reaction treated?

• Diphenhydramine

• Epinephrine

Treatment for severe IgA deficiency?

• precautions before transfusion

• rare condition

How are patients with a history of allergic transfusion reactions managed before transfusion?

• antihistamines/ Benadryl prior to transfusion

• IgA def blood from rare donors

• additive solutions replace residual plasma (adsol)

• platelet products/additive solution (intersol)

How common is Transfusion-Related Acute Lung Injur (TRALI) as a cause of transfusion-related death?

Second leading cause of transfusion-related mortality in the U.S.

When does TRALI typically occur?

During or within 6 hours of transfusion

What are the key symptoms in TRALI?

• Severe hypoxemia

• Respiratory distress

• ARDS (Acute Respiratory Distress Syndrome)

• Dyspnea / tachypnea

• Hypotension

• Pulmonary edema

What is the most common cause of TRALI?

HLA antibodies in donor blood/products

Which donor population is most commonly associated with TRALI?

Multiparous female donors

What is the primary treatment for TRALI?

Supportive respiratory care. improvement within 48 hours from treatment

prevention of TRALI?

• blood products from males

• blood products from females tested for HLA abs

What are the signs and symptoms of bacterial contamination from a transfusion?

• Fever (may be low-grade, as little as ↑ 1°C)

• Rigors (sudden chills) - mimics febrile (non hemolytic) transfusion

• Shivering

• Hypotension → shock

• Tachycardia

• Dyspnea

What is the most common cause of bacterial contamination in blood transfusions?

endotoxin

which are more prone to organisms growing, packed RBC or PLTs? and why?

PLTs

• stored in room temp where orgs prefer

What is the treatment for transfusion-related bacterial contamination?

Immediate IV antibiotic therapy

• NOT ORAL

How is bacterial contamination in blood products prevented?

• Aseptic technique during donor blood collection

• Sterile docking technique when transferring aliquots

• Bacterial testing of products prior to transfusion

• Use of Pathogen Reduction Technology (PRT)

How significant is Transfusion-Associated Circulatory Overload (TACO) in transfusion mortality?

leading cause of transfusion-related mortality in the U.S.

What are the signs and symptoms of Transfusion-Associated Circulatory Overload (TACO)?

• Occurs within 12 hours of transfusion

• Respiratory distress with hypoxemia

• Cough and chest tightness

• Dyspnea

• Hypertension

• Jugular vein distention (JVD)

• Pulmonary edema

What is the common cause of TACO?

Fluid overload from transfusion of one or multiple blood units

How is TACO treated?

• Place patient upright (sitting position)

• Oxygen

• Diuretics

How can TACO be prevented?

Reduce the volume and rate of fluid transfused at one time

What is the cause of Delayed Hemolytic Transfusion Reaction (DHTR)?

undetected RBC antibody, ex: anti-Jka

• 7-10 days post transfusion. DHTR caused by anti-Jka occur up to 14 days later

What type of hemolysis is seen in Delayed Hemolytic Transfusion Reaction (DHTR)?

Extravascular hemolysis

What serum appearance is usually seen in Delayed Hemolytic Transfusion Reaction (DHTR)?

Normal-colored serum: yellow “apple juice”

• Exception: anti-Jka → smoky-grey serum

What is the DAT result in Delayed Hemolytic Transfusion Reaction (DHTR)?

Positive DAT, often weakly positive

How do most patients with Delayed Hemolytic Transfusion Reaction (DHTR) present clinically?

Asymptomatic, with a drop in Hgb/Hct and/or indirect hyperbilirubinemia

If symptomatic, what are the common symptoms of Delayed Hemolytic Transfusion Reaction (DHTR)?

Fever and malaise

Who is at highest risk for Transfusion-Associated Graft-vs-Host Disease (TA-GVHD)?

Immunocompromised patients, including:

• Neonates

• Cancer patients on chemotherapy

What is the common cause of Transfusion-Associated Graft-vs-Host Disease (TA-GVHD)?

Transfusion of viable donor T-lymphocytes into an immunocompromised recipient

What do donor T-cells do once transfused in Transfusion-Associated Graft-vs-Host Disease (TA-GVHD)?

Recognize the recipient as foreign, rapidly proliferate, and attack organs and skin

When do symptoms of Transfusion-Associated Graft-vs-Host Disease (TA-GVHD) usually appear after transfusion?

2 days to 6 weeks post-transfusion

What are the key signs and symptoms of Transfusion-Associated Graft-vs-Host Disease (TA-GVHD)?

• Fever

• Skin rash

• Diarrhea

• Pancytopenia

• Liver dysfunction / jaundice

What is the best treatment for Transfusion-Associated Graft-vs-Host Disease (TA-GVHD) and why?

Prevention, because the mortality rate is extremely high

How is Transfusion-Associated Graft-vs-Host Disease (TA-GVHD) prevented?

• Irradiated blood/ blood components

• HLA-matched organ donors

What treatment may be used once Transfusion-Associated Graft-vs-Host Disease (TA-GVHD) is suspected or in transplant settings?

Anti-rejection medication therapy (immunosuppressants) given before and after transplantation

What is CMV and who is at highest risk?

herpesvirus that can be fatal in neonates and allogeneic bone marrow transplant (BMT) patients

Where is CMV primarily found in blood products?

White blood cells (WBCs)

What are CMV signs & symptoms in infants?

• Rash

• Jaundice

• Hepatosplenomegaly

• Pneumonia

• Seizures

What are CMV signs & symptoms in adults?

• asymptomatic

• Flu-like / mono-like symptoms

• Leukopenia

• Gastroenteritis or pneumonia

What is the common cause of transfusion-associated CMV infection?

Transfusion of CMV+ blood when donor CMV status is unknown or not tested

How is CMV infection treated?

Antiviral therapy (oral or IV)

How is transfusion-associated CMV prevented?

• Serologic testing for CMV → if neg, labeled “CMV-negative”

  • DONT give LR blood, dont want CMV safe

• Use of leuko-reduced (LR) blood products, considered “CMV-safe” in many hospitals