Investigation of Transfusion Reaction Practice Flashcards

Comprehensive practice flashcards covering the definitions, classifications, causes, signs, and formal investigation procedures for transfusion reactions based on hospital lecture notes and documentation.

How is a transfusion reaction (TR) defined in the lecture?

Any transfusion-related adverse event that occurs during or after the transfusion of whole blood, blood components, or human-derived plasma products.

What is the timeframe for an Acute Transfusion Reaction (ATR)?

Signs and symptoms presented during or within $24\,\text{hours}$ of transfusion.

What is the timeframe for a Delayed Transfusion Reaction?

Signs and symptoms presented after $24\,\text{hours}$ of transfusion.

According to the transcript, what are the two root causes of most 'wrong blood into patient incidents'?

1.) Identification errors of patient's blood samples and blood components by hospital staff and 2.) ABO incompatible transfusions.

What are the common causes of major morbidity listed under severe acute transfusion reactions?

Allergy/anaphylaxis, hemolytic reactions, lung injury, circulatory overload, and rare bacterial contamination.

What is the first and most critical step if a serious transfusion reaction is suspected?

STOP the transfusion.

Upon suspecting a reaction, what clinical assessments and matching should be performed immediately?

Assess the patient clinically, start resuscitation if necessary, and check if the details on the ID band match the compatibility label of the blood component.

What three factors underpin the safety of preventing transfusion-transmitted infections?

Voluntary donation, donor selection procedures, and microbiological testing.

What is the definition of Haemovigilance?

The systemic surveillance of adverse reactions and adverse events related to transfusion with the aim of improving transfusion safety.

Who should investigate and review transfusion reactions and adverse events within a hospital?

The hospital transfusion committee.

What is the range of severity for Acute Transfusion Reactions?

They vary from mild febrile or allergic reactions to life-threatening events.

List the categories of reactions included in Acute Transfusion Reactions.

Febrile non-haemolytic, allergic, acute haemolytic (ABO incompatibility), bacterial contamination, TACO, and TRALI.

During monitoring, which specific interval is highlighted for a vital signs check?

The $15\,\text{minutes}$ check.

What are considered severe life-threatening ATRs?

Bacterial transfusion-transmitted infection, acute hemolytic infections, anaphylaxis, TRALI, and TACO.

If a patient develops hypotension during transfusion, why is careful clinical assessment essential?

It may be due to continuing blood loss, in which case continuing the transfusion may be life-saving.

What causes Acute Hemolytic Reactions?

Transfusion of ABO-incompatible red cells which react with the patient's anti-A or anti-B antibodies.

What physiological processes occur during an acute hemolytic reaction?

Intravascular hemolysis, rapid destruction of transfused red cells, and the release of inflammatory cytokines.

Which severe complications can follow an acute hemolytic reaction?

Shock, acute renal failure, and disseminated intravascular coagulation (DIC).

What volume of group A red cells transfused to a group O patient has proven fatal?

$> 30\,\text{ml}$.

What percentage of red cells transfused to the wrong patient result in ABO incompatibility?

$$30\%$.

What specific human errors usually cause ABO incompatible transfusions?

Errors in taking/labelling pre-transfusion samples, collecting components from the blood bank, and failing to perform correct ID checks at the bedside.

List identifying signs and symptoms of general Acute Transfusion Reactions.

Fever, chills, rigors, hyper or hypotension, collapse, flushing, urticaria, pain in bone/muscle/chest/abdomen, respiratory distress, nausea, vomiting, and general malaise.

In which blood component does bacterial contamination most often occur?

Platelet transfusion.

What are the typical signs of a transfusion contaminated with bacteria?

Rigors, fever, hypotension, rapidly developing shock, and impaired consciousness.

How should a suspected contaminated blood unit be managed during investigation?

Inspect for discoloration/aggregates, take patient blood cultures, seal the unit to avoid leakage/contamination, and return it to the laboratory.

What clinical signs suggest a severe anaphylactic reaction?

Shock or severe hypotension associated with wheeze (bronchospasm), stridor from laryngeal edema, or angioedema (swelling of face, limbs, or mucous membrane).

Which blood components are most commonly reported in severe allergic reactions?

Plasma-rich components such as platelets and plasma.

How is a Hypotensive Reaction defined?

An isolated fall in systolic blood pressure by $30\,\text{mmHg}$ or more during or within $1\,\text{hour}$ of transfusion with no allergic reaction or hemorrhage.

What characterizes Febrile Non-Hemolytic Transfusion Reactions (FNHTRs)?

Fever, sometimes accompanied by shivering, muscle pain, and nausea.

When do FNHTRs typically occur?

Up to $2\,\text{hours}$ after completion of transfusion.

Why have FNHTRs become less common recently?

Because leucodepleted blood components were introduced.

What symptoms define a Mild Allergic Reaction?

Itching and/or skin rash with no change in vital signs.

What is the management for a mild allergic reaction?

Transfusion is slowed and the patient is monitored closely for more severe reactions.

What does the abbreviation TRALI stand for?

Transfusion-related Acute Lung Injury.

What is TRALI defined as clinically?

An acute non-cardiogenic pulmonary edema associated with hypoxia occurring during or after blood transfusion.

What is the specific cause of TRALI mentioned in the notes?

Activation of recipient neutrophils by donor-derived antibodies targeting HLA.

Within what timeframe do most cases of TRALI present?

$2-6\,\text{hours}$ of transfusion.

What are the core symptoms of TRALI?

Shortness of breath, severe hypoxia ($< 90\%\,O_2\,\text{Sat}$), hypotension, and fever.

What does the acronym TACO stand for?

Transfusion-associated Circulatory Overload.

What causes the pulmonary edema in TACO?

Volume excess or circulatory overload, resulting in cardiogenic pulmonary edema after large volume or rapid infusion.

What are the common symptoms of TACO?

Acute respiratory distress, tachycardia, hypertension, and acute or worsening pulmonary edema.

What causes a Delayed Hemolytic Transfusion Reaction?

A secondary immune response in a patient who has previously been alloimmunized by blood transfusion or pregnancy.

Which blood group system antibodies are the most common cause of delayed hemolytic reactions?

Kidd blood group system, followed by Rh antigens.

When does hemolysis become clinically apparent in delayed hemolytic reactions?

Up to $14\,\text{days}$ after transfusion.

What are the signs of a Delayed Hemolytic Reaction?

Falling hemoglobin concentration, jaundice, fever, hemoglobinuria, or acute renal failure.

What laboratory investigations confirm a delayed hemolytic reaction?

Blood count, reticulocytes, blood film examination, plasma bilirubin, renal function test, LDH, repeat ABO/crossmatching, and DAT.

What is Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)?

A rare and almost always fatal complication where viable lymphocytes in donor blood engraft and attack the recipient's cells.

Which patients are most at risk for TA-GVHD?

Those with impaired cell-mediated immunity who are unable to reject foreign donor cells.

What details are checked during the Clerical Investigation of a transfusion reaction?

Name of patient, age, sex, blood type, and serial number from both crossmatch result and blood bag.

How is visual check for hemolysis performed during an investigation?

By comparing the post-transfusion sample with the pre-transfusion sample.

Which specific tube type is required for performing a DAT on a post-reaction sample?

An EDTA tube.

What does a positive DAT on a post-reaction sample indicate?

Incompatible cells have been coated with antibodies but not immediately destroyed, often presenting a mixed field agglutination pattern.

What does it mean if the post-reaction sample DAT is negative despite a suspicious reaction?

Calculated as the specimen being drawn several hours later when transfused cells have already been rapidly destroyed.

What is the next step if DAT results are positive or suspicious?

Perform ABO and Rh typing on both post and pre reaction samples, and on the blood unit.

What does a discrepancy in ABO/Rh typing between pre and post samples indicate?

An error in patient or sample identification, such as a sample mix-up or mislabelling.

What is the complete name and address of the medical center on the forms?

Eastern Visayas Medical Center, Tacloban City, Philippines, 6500.

What are the types of request options on the Blood Crossmatching Result Form?

STAT and ROUTINE.

What are the three specific phases listed for blood crossmatching interpretation?

Saline Phase, $37^\circ\text{C}$, and AHG Phase.

Name the five standard blood components listed on the Transfusion Reaction Form.

Whole Blood, Red blood Cells/SRBC, Plasma, Platelet Concentrate, and Cryoprecipitate.

Who must check the appearance of the unit before transfusion as per the record?

RN (Staff Nurse).

What are the four vital signs monitored on the Blood Transfusion Record?

BP, PR, RR, and Temperature.

What must the staff nurse sign for at the end of the transfusion record?

Whether the transfusion was completed without internal reactions or stopped with transfusion reactions noted.

Which four visual criteria are inspected for the blood unit on the investigation report?

Presence of Hemolysis, Bubbles Formation, Presence of Turbidity, and Presence of Greenish Plasma.

From which sites is serologic testing of the post-transfusion sample performed?

The IV site and the Opposite IV site.

What is tested in the urine sample during a reaction investigation?

Urobilinogen.

What is the timeline for urine sample collection after a suspected transfusion reaction?

Immediate, $1\,\text{hour}$ after, and $2\,\text{hours}$ after the reaction.

Who is the Head of the Blood Bank mentioned on the 2019 crossmatch form?

Ernesto N. Miralles, MD, FPSP.

What does the code PATHO-TRIR refer to?

The Transfusion Reaction Investigation Report form code.

What is the date of the revised Transfusion Reaction Investigation Report shown?

$02\text{-April-2020}$.

Which specific reaction is associated with laryngeal edema causing stridor?

Severe Allergic or Anaphylactic Reaction.