Adverse Effects of Blood Transfusion (Exam 3)

What are the three categorical comparisons of transfusion reactions?

- Acute vs. Delayed

- Immune vs. Non-immune

- Infectious vs. Non-infectious

All fatalities associated with transfusion or blood donation must be ______.

reported

Who are these fatalities reported to?

FDA - CBER

What are the three most common causes of transfusion associated fatalities?

- TRALI

- TACO

- TTBIs

If a reaction is expected during transfusion, the physician must ______.

stop the transfusion

The main objective of immunohematology testing is to rule out a ______.

hemolytic transfusion reaction

What are the basic tests involved in pre/post transfusion immunohematology testing?

- Clerical check

- Hemolysis check

- DAT

- ABO testing

Secondary testing can be requested by the ______.

transfusion service physician

What are the organizations that regulate and accredit blook bank labs?

- FDA

- AABB

- CAP

- TJC

Hemovigilance is the collection of data to compare ______.

transfusion reactions

A patient can be exposed to non-ABO antibodies through ...

- Transfusion

- Pregnancy

- Transplantation

Alloimmunization to RBC antigens increases the risk of ______.

hemolytic transfusion reactions (acute or delayed)

What factors can influence alloimmunization risk?

- Underlying disease

- Cause of anemia

- Cumulative number of transfusions

- Immunogenicity of the non-self RBC antigens

Acute hemolytic transfusion reactions (AHTR) occurs usually within ______.

hours (1 hour)

S/Sx of AHTR

- Fever

- DIC

- Acute kidney injury

- Pain, hypotension, hemoglobinuria, hemoglobinemia

AHTR is the destruction of ______ due to recipient antibodies.

donor RBCs

Non-immune AHTR possible causes

- Incompatible fluids

- Mechanical (equipment issues)

- Infections (malaria or babesiosis)

Immune mediated AHTR involves the ______ cascades.

complement/coagulation

Immune mediated AHTR causes ______ (IgM).

intravascular hemolysis

If a post-AHTR appears hemolyzed, what should be done initially?

Request a redraw to verify hemolysis

If the DAT performed post-AHTR gives a new or stronger positive reaction compared to the pre-reaction sample DAT, ______ is needed.

further work-up

Testing of indicators affected by ______ should also be monitored if immune-mediated AHTR is suspected.

intravascular hemolysis (HGB, HCT, bilirubin, haptoglobin, LDH, UA)

Delayed HTR (DHTR) occurs within ______ after transfusion.

days

It must be present with evidence of hemolysis and either a positive ______ or a newly identified ______ in the plasma.

eluate, alloantibody

DHTR occurs most commonly secondarily to an ______ but also may occur during a primary one.

amnestic response

DHTR is often noted when a new sample has a positive ______.

TYSC

What are the implicated antibodies in DHTR?

Protein based (Kidd, Kell, Duffy, M, N)

Delayed serologic transfusion reaction (DSTR) is similar to DHTR but without the ______.

hemolysis

DSTR will occur within ______.

days (with positive DAT/eluate or new alloAb in plasma)

Transfusion related acute lung injury (TRALI) presents ______ S/Sx.

respiratory

TRALI occurs within ______ of transfusion.

6 hours

TRALI is non-______.

cardiogenic (normal BNP/proBNP)

TRALI will show ______ in a lung X-ray.

bilateral infiltrates

______ is considered the leading cause of transfusion-associated fatalities.

TRALI

Immune TRALI has implicated _______ and components.

leukocyte antibodies

Non-immune TRALI affects patients with a ______.

predisposition

Both immune and non-immune TRALI can cause damage to the ______. What does this become?

endothelium

Pulmonary capillary permeability and non-cardiogenic pulmonary edema

Management/treatment of TRALI is ______.

supportive

What is a preventative intervention for TRALI?

Male-only plasma donors (no pregnancy-related Abs)

Transfusion associated circulatory overload (TACO) is an acute ______ (immune/non-immune) complication of transfusion.

non-immune

TACO causes ______ due to increased intravascular volume.

respiratory distress

TACO occurs within ______ of transfusion.

6 hours

What are some causes of TACO?

- Excessive fluid transfused

- Fluid infused too rapidly

- Inability of the patient to accommodate volume (cardiac, pulmonary, renal issues)

S/Sx associated with TACO

- Acute respiratory distress

- CHF

- Hypertension

- Elevated BNP

A chest X-ray done on a patient with TACO will show ______.

pulmonary edema

______ units can be a preventative measure against TACO.

Splitting

Febrile non-hemolytic transfusion reaction (FNHTR) is an ______ complication of transfusion.

acute

FNHTR presents with at least a ______C increase in body temperature.

1C (1.8F)

FNHTR can be accompanied by ...

- Chills

- Nausea and/or vomiting

- Tachycardia

- Increase in BP

- Tachypnea

FNHTR can be ______ mediated.

immune

In immune-mediated FNHTR, ______ antibodies react with donor WBCs.

anti-leukocyte

This reaction causes the release of ______.

inflammatory markers

FNHTR can cause ______ storage changes.

platelet

These platelet storage changes are accompanied by release of ... from white cells.

Chemokines, cytokines, complement components

FNHTR can be prevented with ______.

prestorage leukoreduction

FNHTR can be treated with ______ to reduce fever.

pyretics

Allergic transfusion reactions (ATRs) are very ______, along with FNHTR.

common

ATR is acute and ______ mediated.

immune

ATR occurs as a response of recipient ______ to an allergen present in the blood component and vice versa.

antibodies

These allergens can be ...

Proteins, drugs, food

S/Sx of ATR

- Rash/urticaria

- Flushing

- Pruritis

- Throat tightness

- Shock

- Anaphylaxis

Treatment of ATR

Premedicate with antihistamines, wash blood

Transfusion-associated graft versus host disease (TAGVHD) is a ______ immune transfusion reaction.

delayed (3-30 days)

TAGVHD happens when viable donor ______ in donated blood acts against recipient tissues.

lymphocytes

What are the three main causes of TAGVHD?

- HLA differences

- Immunocompetent cells in graft

- Host incapable of rejecting donor cells

What conditions can lead to development of TAGVHD?

- HLA haplotypes of donor and recipient

-Patient populations at risk for TAGVHD

- Immunocompromised patients

- Close family members

The mortality rate of TAGVHD is ______% with death usually 3-4 weeks after transfusion.

90-100%

S/Sx of TAGVHD

Rash, diarrhea, fever, enlarged liver, marrow aplasia

TAGVHD can be diagnosed via ______ systems.

multi-organ

______ or ______ biopsy can also be used to diagnose TAGVHD.

Skin, liver

______ of cellular blood products prevents TAGVHD.

Irradiation

(Leukoreduction and pathogen inactivation not reliable)

Transfusion-transmitted bacterial infections (TTBI) is an acute ______ transfusion reaction with fever.

non-immune

TTBI is associated with a greater than ______C increase in body temperature and rigors that can be accompanied by hypotension.

2C

TTBI occurs when a ______-contaminated blood component is transfused.

bacteria

RBC components can be contaminated with ...

- E. cloacae

- E. coli

- K. oxytoca

- K. pneumoniae

- P. aeruginosa

- S. marcescens

Platelet components can be contaminated with ...

- S. aureus

- S. epidermidis

- S. lugdunensis

The ______ is a photochemical treatment process approved by the FDA for treatment of plasma and platelets.

Intercept System

The Intercept System uses ______ in the treatment.

psoralen

TTBI can be diagnosed with ______ and ______ in the lab.

gram stain, blood culture

With TTBI, the recipient did not have ______ with the same pathogen before transfusion.

infection

TTBI diagnosis must have the pathogen in at least one of the following:

- The transfused component

- Donor at time of collection

- Additional component prepared from same donation

- Additional recipient of a component from the same generation

Patients receiving multiple platelet transfusions not achieving expected platelet increments following transfusion is called ...

refractoriness to platelet transfusion and alloimmunization

These patients could become allo-immunized to ______ antigens or ______ antigens.

HLA, platelet-specific

For these patients, a ______ is performed following transfusion.

Corrected Count Increment (CCI)

CCI is a platelet count taken ______ post transfusion.

10-60 minutes

CCI takes into account pre/post count plus patient ______.

BSA

CCI does not assess platelet ______.

function

Adverse metabolic effects of transfusion

- Citrate anticoagulant toxicity (hypocalcemia/magnesemia, metabolic alkalosis)

- Hyperkalemia (aging RBC leakage)

Citrate toxicity can be seen with patients receiving ______.

massive transfusions

Hyperkalemia is increased following ______.

irradiation

Allogeneic transfusion has been associated with ...

- Decreased activity of autoimmune diseases

- Impaired wound healing

- Repetitive spontaneous abortions

- Acceleration of HIV and CMV infections

- Earlier/higher rates of colorectal and solid tumor recurrence

- Post-operative bacterial infection

Immunomodulatory effects of transfusion include dysregulation of cellular immunity in ______ cells.

Th1 and Th2

In addition, transfusion can cause decreased ______ function and macrophage activation.

T cell and NK cell