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Hematology > Hematology Week 2: Adverse Transfusion Reactions > Flashcards

Hematology Week 2: Adverse Transfusion Reactions Flashcards

1
Q

Question 1

A
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2
Q

Transfusion risks of bloode-borne infections

A
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3
Q

Prevalence of HIV and Hep C in the US?

A
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4
Q

Window Period

A

The period of time where the viral load is not high enough to be detected by a test

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5
Q

How long is HIVs Window period?

A

9-12 days

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6
Q

How long is Hep C Window period?

A

2 weeks

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7
Q

What is a transfusion reaction?

A
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8
Q

The frequency of transfusion reactions

A

most common Hives/urticaria

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9
Q

What to do for a suspected transfusion reaction?

A

STOP THE TRANSFUSION!

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10
Q

Acute Febrile Transfusion Reactions

3 listed

A

Acute Hemolytic Transfusion Reaction (AHTR)

Febrile Non-hemolytic Transfusion Reaction (FNHTR)

Bacterial Contamination (Septic Reaction)

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11
Q

AHTR AKA

A

Acute Hemolytic Transfusion Reaction

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12
Q

FNHTR AKA

A

Febrile Non-hemolytic Transfusion Reaction (FNHTR)

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13
Q

Septic Reaction AKA

A

Bacterial Contamination

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14
Q

Acute Febrile Reactions Qualifications

A

1*C rise over baseline or if chills/rigors are present

The fever can be something very benign (FNHTR)

or

something very serious

AHTR

Septic transfusion Reaction

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15
Q

When there is a suspected febrile transfusion reaction

3 listed

A

Clerical Check

  • Right blood to the right patient
  • Redo the patients ABO Rh type
  • Recheck crossmatch compatibility

Visual post-transfusion hemolysis check +/- hemolysis

DAT Test

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16
Q

DAT Test for a suspected febrile transfusion reaction

A
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17
Q

AHTR is most commonly caused by?

5 listed

A
  • Preformed antibodies that can activate complement and cause intravascular hemolysis of donor RBCs
  • Often due to ABO incompatible blood
  • Most often from blood administered to the wrong patient
  • Wrong identification of blood specimen
  • Crossmatch error
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18
Q

Classic S&S of AHTR

6 listed

A
  • Fever +/- chills (sometimes this is the only symptom!)
  • Unexplained microvascular bleeding/ DIC
  • Hypotension / shock
  • Gross hemoglobinuria
  • Renal Failure
  • Back/flank pain or pain at the infusion site
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19
Q

Testing for suspected intravascular hemolysis

5 listed

A
  • Positive DAT
  • Haptoglobin significantly decreased
  • LDH Increased
  • Indirect bilirubin increased
  • Urine Hemoglobin Positive
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20
Q

Septic Transfusion Reactions

A
  • Platelets are the highest frequency offender due to room temp storage from common skin flora contaminants (Gram + like staph/strep)
  • RBC transfusions - much rarer than platelet contamination; reactions are usually much more severe Gram - bacteria (yersinia enterocolitica, pseudomonas aeruginosa, serratia marcescens) MUCH MORE SEVERE
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21
Q

Platelets are stored at what temp

A

20-24 *C

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22
Q

Platelets storage needs and properties

A
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23
Q

How platelets are infected

A

Visually exam the unit!!! egg drop soup is no bueno!

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24
Q

Septic Transfusion Reactions Clinical Presentations

A

Fever - High often 2*C inrease

Rigors/chills

Hypotension (prominent)

Tachycardia

Nausea/vomiting

SOB

DIC

Symptoms typically occur very quickly within 15 minutes

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25
Q

Lab features of a septic reaction

4 Listed

A
  • Positive bacterial culture of bag and blood
  • negative DAT
  • Fever that does not respond to anti-pyretics
  • Lab evidence of DIC
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26
Q

FNHTR proposed mechanisms

A

Accumulated cytokines in product

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27
Q

FNHTR Clinical Presentations

A
  • Fever (>1*C) during or soon after transfusion
  • +/- chills or sensation of feeling cold
  • Symptoms often appear towards the end of the transfusion
28
Q

Case 1

A

E gram-positive bacteria such as staph

29
Q

Case 1 part 2

A

D AHTR

30
Q

Acute Dyspneic Transfusion Reactions

3 listed

A
  • Transfusion-related acute lung injury (TRALI)
  • Transfusion associated circulatory overload (TACO)
  • Anaphylaxis
31
Q

Allergic Transfusion Reactions

2 listed

A

Mild Allergic: Cutaneous Symptoms only

Anaphylactoid/anaphylactic: hypotension, dyspnea, stridol, wheezing, GI symptoms, cardiocascular collapse

32
Q

How to treat mild allergic transfusion reactions

A

25-50 mg IV diphenhydramine

33
Q

Anaphylactic vs anaphylactoid

A

Anaphylactic has cardiovascular collapse

34
Q

Anaphylaxis Clinical presentation

A
  • Reactions usually occur 1-45 minutes of transfusion
  • similar to anaphylaxis from other causes
  • as little as a few mL of product can cause laryngeal edema and circulatory collapse
  • sever GI sumptoms (cramping, vomiting, diarrhea)
  • Treat like any other anaphylactic reaction
35
Q

Anaphylaxis Symptoms

6 listed

A
  • Skin findings
  • Angioedema
  • Bronchospasm/wheezing/SOB
  • GI symptoms
  • Hypotension
  • Cardiovascular collapse
36
Q

Anaphylaxis Etiology

A
  • Anti-IgA in IgA deficient patients
  • most commonly patient has preformed antibodies to donor serum proteins
37
Q

Anti-IgA in IgA deficient patients important in

A

anaphylaxis transfusion reaction

38
Q

TACO Mechanism

A

Caused by rapid and/or massive infusion of blood products that results in acute pulmonary edema (induced congestive heart failure)

39
Q

TACO Presentation

A

Must occur within 6 hours of transfusion

  • Dyspnea
  • Cough
  • Tachycardia
  • Hypertension
  • crackles in lung bases
  • Elevated CVP/Pulmonary artery wedge pressure
  • severe headache
40
Q

TACO vs TRALI

A

TACO has Hypertension

41
Q

TACO high-risk patients

A
  • Elderly and small patients
  • Liver/renal failure
  • Positive fluid balance
  • Severe compensated anemia
42
Q

TRALI mechanism

A
  • new acute lung injury that occurs within 6 hours of transfusion
  • of plasma-containing blood products are the most implicated
  • leading cause of transfusion-related mortality 6-10% mortality even if recognized
43
Q

TRALI Presentation

6 listed

A
  • Must occur within 6 hours of transfusion (most occur within 1 hr)
  • hypotension
  • Dyspnea/cyanosis
  • Frothy white fluid from the E.T. Tube
  • Bilateral “white out” on CXR
  • Mechanical ventilation needed to support oxygenation
44
Q

TRALI etiology

A
  • Donor anti-leukocyte antibodies bind recipient leukocytes
  • antibody/WBC complex localizes to the lungs
  • Leukocytes release cytokines and free oxygen radicals that damage the lung
45
Q

Case 3

A

A

TACO and treat with diuretics and oxygen support

46
Q

Delayed Transfusion Reactions

3 listed

A
  • Delayed hemolytic transfusion reaction (DHTR)
  • Post Transfusion Purpura (PTP)
  • Transfusion-associated graft-versus-host disease (TA-GVHD)
47
Q

DHTR AKA

A

Delayed hemolytic transfusion reaction

48
Q

PTP AKA

A

Post Transfusion Purpura

49
Q

TA-GVHD AKA

A

Transfusion-associated graft versus host disease

50
Q

DHTR Mechanism

A

Has a positive DAT against non-ABO antigens

happens after 24 hours <28days

51
Q

DHTR Labs

A

reveal an inadequate rise in Hb or rapid fall in Hgb without other explanation

Haptoglobin decreased

LDH increased

Indirect Bilirubin increased

Transfusion Rx workup: donor blood is now crossmatch incompatible

52
Q

DHTR Crossmatch

A

Donor blood is now crossmatch incompatible as their are new antibodies

53
Q

DHTR Management

A
  • symptomatic treatment (antipyretics)
  • renal failure can occur
  • protect kidneys
  • critical to acoid future transfusion with the implicated RBC antigen
54
Q

PTP Mechanism

A
  • alloantibodies directed against HPA-A1 antigen detected after development of thrombocytopenia
  • Post-transfusion there is a sudden decrease in platelets to less than 20% of pre-transfusion count
  • Occurs 5-12 days post-transfusion and patient has no other conditions to explain thrombocytopenia
55
Q

PTP high risk patients

A
  • women
  • prior sensitizing events such as pregnancy or transfusions
56
Q

PTP Treatment

4 listed

A
  • IVIG
  • +/- steroids
  • do not transfuse addition random donor platelets
  • if the clinical situation demands a platelet transfusion: use HPA-A1 platelets
57
Q

TA-GVHD Mechanism

A
58
Q

TA-GVHD Onset

A

4-30 days

59
Q

TA-GVHD Symptoms

3 listed

A
  • fever
  • rash
  • diarrhea
60
Q

TA-GVHD Lab findings

A

pancytopenia

liver function abnormalities

61
Q

TA-GVHD Treatment

A

Bone Marrow transplant ready to go otherwise not much you can do

62
Q

TA-GVHD Prevention

A
63
Q

Acute Febrile Transfusion Reactions Diagnostic Clues

A
64
Q

Acute Dyspneic Transfusion Reactions Diagnostic Clues

A
65
Q

Take home points of Adverse Transfusion Reactions

A

Hematology (26 decks)

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