TRANSFUSION REACTION (2-FINALS)

IgM

TRANSFUSION REACTIONS

• Adverse reactions associated with the transfusion of blood and its components

• Non-threatening to fatal

• Hemolytic or non-hemolytic

  • may or may not cause RBC destruction

• Acute to delayed

  • Acute/immediate (_____-Intravascular Hemolysis)- rapid onset; within minutes after transfusion. Less than 24 hours after the transfusion

IgG

TRANSFUSION REACTIONS

• Acute to delayed

  • Delayed (____- Extravascular Hemolysis)- days to weeks after transfusion. More than or equal to 24 hours

• Reactions may involve antigen-antibody interactions (immunologic or non immunologic)

• May involve infectious agents (infectious or non-infectious)

ABO compatible blood

• To prevent IHTR, you must give _________

Immediate Hemolytic Transfusion Reaction (IHTR)

ACUTE IMMUNOLOGIC REACTIONS

• Most common cause is ABO incompatibility (clerical error)

• Red cell destruction due to complement activation by IgM (within 24 hours)

• As little as 10-15 mL can trigger a reaction

• Anti-A, Anti-Kell, Anti-Jka, Anti-Fya

Febrile Non-Hemolytic Transfusion Reaction (FNHTR)

ACUTE IMMUNOLOGIC REACTIONS

• CAUSE: patient’s anti-leukocyte antibodies reacts with donor’s leukocytes (HLA)

• Not life threatening

• Antipyretics are used to treat fever or are given as a preventive measure

• Aspirin not used because of its effect on platelet function

• Leukocyte reduced units may also be given

Allergic Transfusion Reaction/Urticarial reaction

ACUTE IMMUNOLOGIC REACTIONS

• CAUSE: Patient develops allergy to donor’s plasma proteins

• Cutaneous hypersensitivity

• A mild transfusion reaction causes:

  • Urticarial Reaction: hives, itching

  • Erythema: redness of the skin

  • Dyspnea: shortness of breath

• An antihistamine can be given prior to transfusion or during transfusion

• Not life threatening

Anaphylactic Transfusion reaction

ACUTE IMMUNOLOGIC REACTIONS

• CAUSE: patient’s anti-IgA reacts with donor’s IgA

• Very severe & life threatening allergic reaction although rare

• Patient is IgA deficient

• Treated with Epinephrine (vasoconstrictor & bronchodilator)

• Life threatening

• The patient is IgA deficient

Anaphylactoid transfusion reactions

ACUTE IMMUNOLOGIC REACTIONS

• Occurs in patients with normal levels of IgA but has limited type-specific anti-IgA that reacts with the light chain of the donor’s IgA

• Not life threatening

Transfusion Related Acute Lung Injury (TRALI)

ACUTE IMMUNOLOGIC REACTIONS

• Also known as: Non-cardiogenic Pulmonary Edema or Allergic Pulmonary Hypersensitivity

• Cause: Patient’s Anti-leukocyte Antibodies Reacting With Donor’s Leukocytes or Vice Versa

• The lungs fill with a high-protein fluid

• Patient displays acute respiratory insufficiency with x-ray showing bilateral symmetric pulmonary edema- WBC emboli

• 1 in 5,000 transfusions

• Symptoms occur within 2 hours and may end in 2-4 days if treated

• Treated with IV steroids, although they may not work well

Leukoreduced RBCs, Limit transfusion

ACUTE IMMUNOLOGIC REACTIONS (TRANSFUSION RELATED ACUTE LUNG INJURY)

• Recipient Antibody: Give ___________

• Donor Antibody: Must ___________

Bacterial Contamination Reactions

ACUTE NON-IMMUNOLOGIC REACTIONS

• Does not involve antigen-antibody interactions

• Results from bacterial contamination of blood products

  • Yersinia enterocolitica

  • Serratia liquifaciens

  • E.coli

  • Pseudomonas fluorecens

• Common bacterial contamination: Platelet Concentrate

Transfusion Associated Circulatory Overload (TACO)

ACUTE NON-IMMUNOLOGIC REACTIONS

• Cause: Transfusion of blood to patients at a very fast rate

• Normal rate of transfusion: 200 mL/hour

• Iatrogenic Transfusion Reaction

• Elderlies, newborns, sickle cell disease, heart and kidney problems

• Hypervolemia →Pulmonary Edema → Congestive Heart Failure

• Transfusion rate should be lessened to 100 mL/hour.

Physical/Chemical Induced Transfusion Reaction

ACUTE NON-IMMUNOLOGIC REACTIONS

• Physical RBC Damage

• Depletion and dilution of coagulation

• Hypothermia

• Citrate toxicity

• Hypokalemia

• Hyperkalemia

• Air embolism

Delayed Hemolytic Transfusion Reaction (DHTR)

DELAYED IMMUNOLOGIC REACTIONS

• occur at least 24 hours after transfusion (3-7 days after transfusion)

• Mediated by IgG antibodies

  • Patient previously exposed to RBC antigen and has low antibody titer until exposed again

  • Rh, Kidd, Duffy, and Kell

• DAT negative at first, but becomes positive

• Must give antigen negative blood

• Elution is performed to identify Antibody

• Must give Antigen negative blood

• The reaction occurred for more than 24 hours after the transfusion

• It requires 2 IgG

KIDD blood group system

• Most common cause of Delayed hemolytic transfusion reaction is __________________

Alloimmunization

DELAYED IMMUNOLOGIC REACTIONS

• May result from previous blood transfusion

• Symptoms may be mild: falling hemoglobin and hematocrit levels; severe: platelet refractoriness with bleeding

• If the mother is Rh negative and the first child is Rh positive

• The mother immune system will be activated and then produce an antibody against the antigen

Post-Transfusion Purpura (PTP)

DELAYED IMMUNOLOGIC REACTIONS

• Cause: frequent or multiple platelet transfusion

• Usually occurs in multiparous women who do not have the antigen

• About 5-10 days after being transfused with platelets, the platelet count drops <10,000/μL

• Cerebral hemorrhage is a major concern

• Possibly treat with corticosteroids or intravenous immunoglobulin therapy (IVIG)

• You will see reddish patches on the skin

• There is abrupt onset of Severe thrombocytopenia

• Normal Platelet count: 150,000-450,000 um

Transfusion-Associated Graft Versus Host Disease

DELAYED IMMUNOLOGIC REACTIONS

• Cause: Donor’s T-lymphocytes proliferating and destroying cells and organs in the patient’s body

• Rare but fatal condition that has a 90% mortality rate

• Symptoms appear after about 12 days

• May be caused by donor lymphocytes transfused into an immunocompromised recipient, fetuses receiving intrauterine transfusion, NBs receiving exchange transfusion and patients receiving blood components from relatives

• Pancytopenia occurs as a result of the immunologic response

• Any components that contain T-lymphocytes should be irradiated to prevent GVHD

Transfusion-Induced Hemosiderosis/Iron Overload

DELAYED NON-IMMUNOLOGIC REACTIONS

• DUE TO FREQUENT BLOOD TRANSFUSION

• Occurs in individuals who receive multiple transfusions

• Excess iron accumulates in macrophages in various tissues (liver, heart, endocrine glands)

• Each unit of Blood has 225 mg Iron

• It appears as dark brown granules in the cells

• May lead to organ failure

• Iron chelation therapy may help: DESFERRIOXAMINE

Immunosuppression

DELAYED NON-IMMUNOLOGIC REACTIONS

• A generalized, non specific effect that diminishes the activity of the recipient’s immune system soon after blood component(s) transfusion.

• Sudden decrease activity of the immune system