CHPTER -TEN
TRANSFUSION REACTION
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Learning objectives
At the end of this chapter, the student will be able to:
Define the transfusion reaction
Classify the transfusion reactions
Carry out laboratory tests to detect causes of
transfusion reactions
Investigate the causes of transfusion reactions
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Transfusion Reaction
Definition
Any unfavorable consequence of blood transfusion.
Also called Adverse Effects of Blood Transfusion
The risks of transfusion must be weighed against
the expected therapeutic benefits.
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Classification of Transfusion Reactions
Severity-Non threatening to fatal
RBC destruction
Hemolytic
non-hemolytic
Onset
Acute – rapid onset
Delayed – days to weeks
Reactions may involve antigen-antibody interactions
May involve infectious agents.
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I. ACUTE -IMMUNOLOGIC
TRANSFUSION REACTION
1. Hemolytic Transfusion Reactions (HTR)
Immunologic
Onset within minutes to hours (<24 hours)
Associated with Intravascular Hemolysis
Etiology: Antibodies that activate complement
ABO antibodies are predominant but not the only ones
implicated.
As little as 10-15 mL can trigger a reaction
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Symptoms of HTR
Fever
Chills
Acute renal failure
Early signs
Anxiety
Pain at infusion site
Back/chest pain
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HTR Maintenance
To prevent renal failure, fluids (saline) are infused
along with diuretics (furosemide) to increase urine
output
How do you prevent HTR?
• SOPs to avoid clerical errors
• Perform pre transfusion compatibility testing
- Give ABO compatible blood.
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2. Febrile Non hemolytic TR
Cause: - Recipient antibodies to donor leukocyte
antigens
Symptoms:
Raises temperature >1°C (fever)
Chills with fever
Shaking
prevention: - Antipyretics are used to treat fever
Aspirin not used
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Febrile Non hemolytic TR
Seen in…
Multiply transfused patients
Multiple pregnancies
Previously transplanted
Must rule out…
Hemolytic transfusion reaction
Bacterial contamination of unit
Prevention:
Leukocyte reduction or depletion of component.
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3. Allergic Transfusion Reactions
May be caused by antibodies (recipient) to plasma
proteins (donor)
A mild transfusion reaction causes:
Urticarial Reaction: hives, itching
Erythema: redness of the skin
Dyspnea: shortness of breath
antihistamine can be given prior to or during transfusion
Not life threatening
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Anaphylactic Reactions
May be associated with IgA antibodies
Very severe & life threatening allergic Rxn although rare
Symptoms:
- NO fever Hypotension
- Skin flushing Cardiac arrhythmia
- Nausea Cardiac arrest
- Diarrhea Laryngeal edema
Rt:- epinephrine (vasoconstrictor & bronchiole dilator)
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4. Transfusion Related Lung Injury(TRALI)
Caused by donor antibodies that react with the
recipient’s granulocytes or vice versa
The lungs fill with a high-protein fluid
Patient displays acute respiratory insufficiency with
x-ray showing bilateral symmetric pulmonary edema
Dyspnea, cyanosis, tachycardia, and hypoxemia
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TRALI
symptoms may occur within 2 hours and may end in 2-4
days if treated
1 in 5,000 transfusions
Rt: with IV steroids, although they may not work well
Prevention: Avoid donations from multiparous women
and those who have received multiple transfusions
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B. Acute Non-immunologic Reactions
1. Bacterial Contamination
Does not involve antigen-antibody interactions
Results from bacterial contamination of blood
- Yersinia enterocolitica
- Serratia liquifaciens
Symptoms appear rapidly:
- include fever, shock, & renal dysfunction (due to
endotoxins), nausea, vomiting
Stop immediately and treat with antibiotics
- Hypotension can bedembelot(bsc,Msc)
treated with vasopressors 15
2. Circulatory Overload
Occurs when a patient is transfused too rapidly,
overloading the cardiopulmonary system (too much
fluid at one time)
Symptoms: Cyanosis, Dyspnea, Severe headache
and Congestive Heart Failure (CHF)
Place patient in upright position
Give patients small aliquots of each unit over time to
prevent reaction
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3. Physically or Chemically Induced Red Cell Destruction
Etiology: Destruction of red blood cells in the collection bag
and infusion of free hemoglobin, etc.
Improper temperatures: High or Low
Osmotic Hemolysis
Mechanical Hemolysis
Hypocalcemia
Hypothermia
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II. DELAYED TRANSFUSION
REACTION
A. Delayed Immunologic Reactions
1. Delayed HTR
Onset within days (Anamnestic response, >24 hours)
Associated with Extravascular Hemolysis
Etiology: Abs that usually do NOT activate Complement:
-Rh, Kidd, Duffy, and Kell
DAT negative at first, but becomes +
Elutions are performed to identify Ab
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Cont.
Symptoms include:
– Fever
– Gradual Hemoglobin
– Fever
– Jaundice
– Hemoglobinuria
Prevention: Give antigen negative blood
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2. Graft-versus-Host Disease
(Transfusion Related)
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
Pancytopenia occurs as a result of the immunologic
response
Any components that contain T-lymphocytes should be
irradiated to prevent GVHD
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3. Post Transfusion Purpura
Alloantibody directed against a high-incidence platelet
Ags
Usually occurs in multiparous women who do not have
the Ags
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 therapydembelot(bsc,Msc)
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B. Delayed Non-immunologic Reactions
1. Transfusion-Induced Hemosiderosis
Occurs in individuals who receive multiple transfusions
Excess iron accumulates in macrophages in various
tissues (liver, heart, endocrine glands)
It appears as dark brown granules in the cells
May lead to organ failure
Iron chelating therapy may help
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2. Disease Transmission
Hepatitis Malaria
HIV Babesiosis
HTLV Syphilis
Cytomegalovirus
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Investigating a Transfusion Reaction
What should the medical team do?
Stop the transfusion immediately
Saline is maintained in the IV line
Physicians are notified
Blood samples are sent to the lab only in cases of:
Acute HTR
Anaphylaxis
TRALI
Bacterial contamination
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Post Transfusion Lab Testing
1. Several tests should be performed:
First look for hemolysis or icterus
• Hemoglobin
• Bilirubin
2. Direct Antiglobulin Test (DAT)
Recipient post-tx’n spec.
Positive? Perform eluate and identify antibody
Identify discrepancies
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Post Transfusion Lab Testing
3. ABO Grouping and Rh Typing
Recipient pre-transfusion and post-transfusion specimen
Donor segment and bag
It rule-out a clerical error
4. Cross match
Recipient pre-transfusion sample with unit and pre-transfusion
sample with segment
Recipient post-transfusion sample with unit and post-transfusion
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Post Transfusion Lab Testing
5. Indirect Antiglobulin Test (IAT)
Recipient Pre- & post-transfusion reaction specimens
Positive? Identify antibody
Additional samples sometimes required:
Post reaction urine sample
Blood cultures
HLA or neutrophil antibodies (serum/gel)
Anti-IgA antibodies (serum/gel)
HLA typing (ACD)
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