Blood Banking - Lecture - 15 - Transfusion Reactions / Adverse Effects of Blood Transfusion - Part 1 - Complete

T

T/F

Blood transfusion is generally safe

F

T/F

Blood transfusion is risk-free

Adverse Event

An unintended and deleterious occurrence associated with blood component transfusion. It may occur before, during, or after a transfusion

Includes Incidents and Adverse Reaction

Incidents

Any error that could affect the quality or effectiveness of a blood product or could have led to an adverse reaction to a transfusion recipient.

Adverse Reaction

A harmful effect observed in a transfusion recipient that is temporally associated with a blood component transfusion

Foreign antigens

Cause of reactions that lead to immune response

Plasma proteins

Cause of reactions that lead to allergic reactions

Contamination

Cause of reactions that lead to bacterial reactions

Infectious agents

Cause of reactions that lead to transfusion-transmissible infections

Febrile Non-hemolytic Transfusion Reaction

Transfusion-related adverse reaction

Most common

Febrile Non-hemolytic Transfusion Reaction

Transfusion-related adverse reaction

RBC Transfusions

Allergic Transfusion Reaction, non-severe

Transfusion-related adverse reaction

Platelet & Plasma Transfusions

Acute Hemolytic Transfusion Reaction

Transfusion-related adverse reaction

Most dangerous (Acute)

Transfusion-related Acute Lung Injury, Transfusion-associated Circulatory Overload

Transfusion-related adverse reaction

Leading causes of death

Transfusion-associated Graft-Versus-Host Disease

Transfusion-related adverse reaction

Rarest with high mortality

Febrile Non-hemolytic Transfusion Reaction

Transfusion-related adverse reaction

86.4 per 100,000 all components transfused

Allergic Transfusion Reaction, non-severe

Transfusion-related adverse reaction

104.1 per 100,000 all components transfused

Acute Hemolytic Transfusion Reaction

Transfusion-related adverse reaction

2.0 per 100,000 all components transfused

Transfusion-related Acute Lung Injury

Transfusion-related adverse reaction

1.2 per 100,000 all components transfused

Transfusion-associated Circulatory Overload

Transfusion-related adverse reaction

9.1 per 100,000 all components transfused

Transfusion-associated Graft-Versus-Host Disease

Transfusion-related adverse reaction

0.01 per 100,000 all components transfused

Mandatory Hemovigilance Systems

Transfusion-associated fatalities are reported through this system

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T/F

Transfusion-associated fatalities still happen despite safety measures

Acute Hemolytic Transfusion Reaction

Transfusion-related adverse reaction

Hemolytic reactions

Transfusion-transmitted Bacterial Infection

Transfusion-related adverse reaction

Bacterial contamination

Clinical Recognition, Laboratory Investigation

2 critical component of recognizing and evaluating transfusion reactions

Nurse, Physician

Professional who does Clinical Recognition

Signs, Symptoms

Critical component of recognizing and evaluating transfusion reactions

What is identified in Clinical Recognition?

Stop transfusion immediately

Clinical Recognition

Immediate Action

Send specimens to laboratory, Follow standard protocol

Clinical Recognition of transfusion reaction

Next Step after Immediate Action

≥39°C or ≥2°C rise

Signs and symptoms of transfusion reactions

Fever

O2 sat <90%

Signs and symptoms of transfusion reactions

Hypoxemia

Rapid heart rate >120/min or >40/min rise

Signs and symptoms of transfusion reactions

Tachycardia

Rapid breathing >28/min

Signs and symptoms of transfusion reactions

Tachypnea

Rise in systolic BP >30 mmHg

Signs and symptoms of transfusion reactions

Hypertension

Drop in systolic BP >30 mmHg

Signs and symptoms of transfusion reactions

Hypotension

Hematuria

Signs and symptoms of transfusion reactions

Blood in urine

Hemoglobinuria

Signs and symptoms of transfusion reactions

Hemoglobin in urine

Nausea

Signs and symptoms of transfusion reactions

-or Vomiting

Urticaria

Signs and symptoms of transfusion reactions

Hives

Pruritis

Signs and symptoms of transfusion reactions

Itching

Bronchospasm

Signs and symptoms of transfusion reactions

Wheezing

Chills

Signs and symptoms of transfusion reactions

aka Rigors

Pain

Signs and symptoms of transfusion reactions

Abdominal, back, chest, infusion site, headache

Oliguria or anuria

Signs and symptoms of transfusion reactions

Decreased or absent urine output

Disseminated intravascular coagulation

Signs and symptoms of transfusion reactions

DIC

Rash, Pulmonary edema

Signs and symptoms of transfusion reactions

Others

Rule out hemolytic transfusion reaction

Critical component of recognizing and evaluating transfusion reactions

Main goal of Laboratory investigation

Mislabeling

Transfusion Laboratory investigation

Check patient & unit identification. Give a common clerical error

ABO typing

Transfusion Laboratory investigation

This test is repeated

Hemolysis

Transfusion Laboratory investigation

What is inspected for in pre- and post-transfusion specimens?

Direct Antiglobulin Test

Transfusion Laboratory investigation

This test is performed

Blood bank physician

Transfusion Laboratory investigation

Result is reported to this blood bank personnel, to determine further

testing

Transfusion service physician

Transfusion service:

(Laboratory technologist/Transfusion service physician)

Evaluate initial transfusion reaction workup

Laboratory technologist

Transfusion service:

(Laboratory technologist/Transfusion service physician)

Perform additional testing as per transfusion service physician orders

Laboratory technologist

Transfusion service:

(Laboratory technologist/Transfusion service physician)

Perform primary testing on postreaction sample

Transfusion service physician

Transfusion service:

(Laboratory technologist/Transfusion service physician)

Order additional testing as needed

Transfusion service physician

Transfusion service:

(Laboratory technologist/Transfusion service physician)

Report to patient physician immediately if hemolysis, bacterial contamination, TRALI, or other serious adverse event related to transfusion is suspected

Laboratory technologist

Transfusion service:

(Laboratory technologist/Transfusion service physician)

Report findings to the transfusion service physician

Transfusion service physician

Transfusion service:

(Laboratory technologist/Transfusion service physician)

Generate a final transfusion report, including interpretation of the transfusion reaction and recommendations for future transfusions

Transfusion service physician

Transfusion service:

(Laboratory technologist/Transfusion service physician)

Notify blood center and other outside agencies if applicable

Clerical check

Basic Testing Post-Transfusion Reaction Sample

Check that the following information matches:

• Postreaction sample

• Transfusion documentation

• Blood bag (when available)

Discrepancy

Basic Testing Post-Transfusion Reaction Sample - Clerical check

(No discrepancy/Discrepancy)

↓

Notify TS Physician

↓

If another patient is involved in discrepancy, take necessary step to prevent another adverse event

↓

Go to secondary testing if requested by TS physician

Hemolysis check

Basic Testing Post-Transfusion Reaction Sample

A visual check for:

• Free hemoglobin will manifest as a pink or reddish discoloration of the plasma

Hemolysis present

Basic Testing Post-Transfusion Reaction Sample - Hemolysis check

(No discrepancy/Hemolysis present)

↓

Request redraw

↓

Second Draw.

↓

Hemolysis present on second draw

↓

Notify TS physician

↓

Go to secondary testing if requested by TS physician

Direct Antiglobulin Test

Basic Testing Post-Transfusion Reaction Sample

Detects the presence of red blood cells sensitized in vivo

Negative

Basic Testing Post-Transfusion Reaction Sample - Direct Antiglobulin Test

(Negative/Positive)

↓

'If suspect HTR

↓

Notify TS physician

↓

Go to secondary testing if requested physician

Positive

Basic Testing Post-Transfusion Reaction Sample - Direct Antiglobulin Test

(Negative/Positive)

↓

Notify TS physician

↓

Go to secondary testing if requested physician

ABO Testing

Basic Testing Post-Transfusion Reaction Sample

To verify patient ABO typing

Discrepancy

Basic Testing Post-Transfusion Reaction Sample - ABO Testing

(No discrepancy/Discrepancy)

↓

Request redraw

↓

Discrepancy revealed

↓

If another patient is involved in discrepancy, take necessary steps to prevent another adverse event

↓

Notify TS physician

↓

Go to secondary testing if requested by TS physician

Non-infectious Transfusion reactions, Infectious Transfusion Reactions

Major Risk Categories for Transfusion Reactions

Non-infectious Transfusion reactions

Major Risk Category for Transfusion

-Acute Hemolytic Transfusion Reaction

-Delayed Hemolytic Transfusion Reaction

-Delayed Serological Transfusion Reaction

-Transfusion-related Acute Lung Injury

-Transfusion-associated Circulatory Overload

-Transfusion-Associated Dyspnea

-Febrile Non-Hemolytic Transfusion Reaction

-Hypotensive Transfusion Reaction

-Acute Transfusion Reactions

-Adv. Rx to Infusion of Plasma-Derived Products

-Post-Transfusion Purpura

-Transfusion-Associated Graft-Versus-Host Disease

Infectious Transfusion Reactions

Major Risk Category for Transfusion

Transfusion-transmitted Bacterial Infection

Acute hemolytic transfusion reaction

Is the accelerated destruction of transfused RBCs due to antibody-mediated incompatibility

Acute hemolytic transfusion reaction

Defined as the combination of signs and symptoms associated with hemolysis, biochemical evidence of hemolysis, and serologic evidence of RBC incompatibility occurring during or within 24 hours after transfusion.

Most occur within minutes after the start of transfusion or within a few hours post transfusion

Onset of Acute hemolytic transfusion reaction

Directly proportional

Relationship of the severity of the Acute hemolytic transfusion reaction to the amount of incompatible blood transfused.

10-15 mL

Volume it takes for incompatible blood to trigger AHTR

Fever

Most common symptom of Acute hemolytic transfusion reaction

Increased BUN, Creatinine

Laboratory results in Acute hemolytic transfusion reaction that means Acute Kidney Injury

Shock, DIC

Main cause of renal dysfunction after hemolysis in Acute hemolytic transfusion reaction

Early and aggressive fluid resuscitation and BP management

First step in management of Acute hemolytic transfusion reaction

Early and aggressive fluid resuscitation and BP management

Management of Acute hemolytic transfusion reaction that lowers the concentration of hemoglobin going to the kidneys because hemoglobin is toxic to the renal tubules.

Kidneys

Viral organ for blood pressure control

Coagulation testing, Platelet count

Testing for DIC

PT, APTT, D-Dimer

Coagulation tests for DIC

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T/F

Acute hemolytic transfusion reaction

can also happen in ABO-mismatched platelet transfusions

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T/F

Acute hemolytic transfusion reactions

may also occur in patients who are unable to report symptoms (Infants, young children, unconscious patients, mentally

impaired, and anaesthetised, Surgery or ICU patients)

Decreased

Laboratory tests confirming hemolysis

Fibrinogen

Decreased or absent

Laboratory tests confirming hemolysis

Haptoglobin

Elevated

Laboratory tests confirming hemolysis

Bilirubin

Elevated

Laboratory tests confirming hemolysis

LDH

Hemoglobinemia

Laboratory tests confirming hemolysis

Hemoglobin

Hematuria

Laboratory tests confirming hemolysis

Urine

Spherocytes

Laboratory tests confirming hemolysis

RBC morphology

T

Laboratory tests confirming hemolysis

T/F

Inadequate rise of post-transfusion hemoglobin level or rapid fall of hemoglobin after transfusion

Polyspecific, Anti-IgG, Anti-C3

Serologic Evidence of Immune-Mediated HTR

DAT is positive for

Positive

Serologic Evidence of Immune-Mediated HTR

Elution test result with identification of one or more alloantibodies