Non-hemolytic Non-hemolytic Transfusion ReactionTransfusion Reaction

Group members:Group members:(2006838514)(2006838514)(2005604631)(2005604631)(2006838393)(2006838393)(2006838665)(2006838665)

Febrile ReactionsFebrile Reactions

Etiology

•Most commonly reported transfusion rxns

•Most common type – due to cytotoxic antibodies / leukoagglutinins (leukocyte antibodies)

•If these antibodies present in the recipient's plasma, a rxn occur btwn the ab & the ag of transfused leukocytes / platelets

Signs & Symptoms

•Fever, often accompanied by chills whichbegins during / soon aft transfusion

•Fever associated wif a febrile non – hemolytic rxn defined as a rise in body temp of 1oC / >, occurring in association wif da transfusion of blood / components

Prevention

•Documenting da existence of leukoagglutinins

•Tests such as leukoagglutinins & microlymphototoxicity assays

•Leukocyte – poor preparations is recommended (only after a patient has had 2 / > febrile non – hemolytic rxns

Circulating OverloadCirculating Overload

Etiology

•Can result from rapid transfusion of large volumes of blood w/o equivalent blood loss

•Can also occur aft transfusion of small amounts of blood to patients wif abnormal cardiac f(x) & reserve

Signs & Symptoms

• Typical symptoms:

1.Severe headache

2.Dyspnea

3.Cyanosis

4.Congestive heart failure

- Pulmonary edema develop

Prevention

•Use of packed erythrocytes

•Administered slowly – for patients dat r x actively bleeding / susceptible to circulatory overload

•Preferable to hv patient in a sitting position

•Prefer to divide full units of packed red cells in half – 1 divided unit trannsfused while da other remains refrigerated (some clinicians)

•Da attending physician may also order da administration of a diuretic medication to reduce fluid retention

•In patients wif low hematocrits (15-20%),phlebotomy of whole blood followed by da transfusion of packed red cells may be useful in increasing O2 – carrying capacity w/o expanding blood volume

Bacterial contaminationBacterial contamination

IntroductionIntroduction

Rare but life threatening and Rare but life threatening and very serious acute transfusion very serious acute transfusion reaction (rxn).reaction (rxn).

Non-immunologic transfusion Non-immunologic transfusion rxnrxn doesn’t involve Ag-Ab rxn. doesn’t involve Ag-Ab rxn.

Bacteria may multiply during Bacteria may multiply during storage storage

Gram positive and Gram Gram positive and Gram negative organisms have been negative organisms have been implicated.implicated.

Causes/SourcesCauses/Sources

Donor’s skinDonor’s skin Donor’s bacteremiaDonor’s bacteremia Contaminated equipments during Contaminated equipments during

blood collection/processing .blood collection/processing .

Bacterial growth in Bacterial growth in plateletsplatelets

Platelet storage T is ideal for Platelet storage T is ideal for proliferation of many types of bacteria proliferation of many types of bacteria ( 20-24( 20-24C).C).

Platelets are the components in which Platelets are the components in which bacterial contamination is most often bacterial contamination is most often detected.detected.

Large proportion of platelets are Large proportion of platelets are administered to patients who are administered to patients who are immunosuppressed - immunosuppressed - ↑ ↑ risk of risk of infection.infection.

Bacterial growth in RBCsBacterial growth in RBCs

Some organisms grow well in cold Some organisms grow well in cold storage - transfusion of red cells storage - transfusion of red cells containing such psychrophilic Gram-containing such psychrophilic Gram-negative bacteria negative bacteria no complications no complications to fatalities.to fatalities.

E.g. E.g. Yersinia enterocolitica, E.coliYersinia enterocolitica, E.coli Almost always associated with donors Almost always associated with donors

having asymptomatic bacteraemia.having asymptomatic bacteraemia.

SymptomsSymptoms

Very high fevers (hyperpyrexia)Very high fevers (hyperpyrexia) RigorsRigors Profound hypotensionProfound hypotension NauseaNausea DiarrhoeaDiarrhoea DyspnoeaDyspnoea Vomiting Vomiting *minutes after starting transfusion/ *minutes after starting transfusion/

delayed several hoursdelayed several hours

ManagementManagement

Immediately stop the transfusion Immediately stop the transfusion and notify the hospital blood bank. and notify the hospital blood bank.

After initial supportive care, blood After initial supportive care, blood cultures should be taken (fm pt) cultures should be taken (fm pt) and broad-spectrum antimicrobials and broad-spectrum antimicrobials commenced. commenced.

Laboratory investigation will Laboratory investigation will include culture and Gram staining include culture and Gram staining of the implicated component.of the implicated component.

Anaphylactic typeAnaphylactic type

IntroductionIntroduction

One of the most severe & rare One of the most severe & rare rxns. rxns.

Can occur after as little as a few Can occur after as little as a few mLs of transfused bld.mLs of transfused bld.

Rxns are very severe and can be Rxns are very severe and can be life threatening if no prompt life threatening if no prompt actions taken.actions taken.

CausesCauses

Patients with IgA deficiency Patients with IgA deficiency anti Ig-A Ab.anti Ig-A Ab.

Ig A Ig A found in most people, found in most people, also in plasma that accompanies also in plasma that accompanies donated RBCs, platelets, FFP, & donated RBCs, platelets, FFP, & cryo.cryo.

SymptomsSymptoms

Anaphylactic and anaphylactoid Anaphylactic and anaphylactoid reactions have signs of cardiovascular reactions have signs of cardiovascular instability including:-instability including:-

HypotensionHypotension TachycardiaTachycardia Loss of consciousnessLoss of consciousness Cardiac arrythmiaCardiac arrythmia ShockShock Cardiac arrestCardiac arrest* sometimes respiratory involvement * sometimes respiratory involvement

with dyspnoea and stridor are with dyspnoea and stridor are prominent prominent

Unlike Non-hemolytic febrile Unlike Non-hemolytic febrile transfusion rxn & hemolytic transfusion rxn & hemolytic transfusion rxn, this transfusion transfusion rxn, this transfusion rxn x demonstrate with a fever.rxn x demonstrate with a fever.

Other common signs are :-Other common signs are :- skin flushing skin flushing VomitingVomiting DiarrheaDiarrhea

ManagementManagement

Immediately stop transfusion.Immediately stop transfusion. supportive care including airway supportive care including airway

management may be required. management may be required. Adrenaline/epinephrine may be Adrenaline/epinephrine may be

indicated indicated hypotension. hypotension. Ig levels and anti-IgA Abs should Ig levels and anti-IgA Abs should

be investigatedbe investigated Pt Pt given IgA deficient plasma given IgA deficient plasma

(sp ordering).(sp ordering).

Allergic reaction:

• Common transfusion reaction, can be mild, moderate, or life-threatening

• One may experience these…

Urticaria, pruritis, rash, flushing

Dyspnea

Anxiety

Wheezing

Hypotension

Nausea

• Indistinguishable on examination from most food or drug allergies

pruritis

urticaria

•Those clinical presentation suggest - expose to foreign substances in the blood product to which the recipient is sensitized.

•IgE-mediated

Transfused soluble Ag – react with IgE molecule – degranulation – allergic mediators…..

YYYYYY

YYYY

YY

IgE

Histamine

IgE bound to mast cells waspreformed in response to exposure to an antigen.

Mast cells contain histamineand circulate with boundIgE.

Y

YY

YY

Y

A

Antigens from plasmabind to pre-formed IgEattached to mast cells

Y

Y

YY

Y

Y

B

Antigen binding causesactivation of histaminerelease mechanism frommast cells.

Y

Y

YY

Y

Y

C

Histamine is releasedfrom mast cells and causes increase in vascular permeability

WHAT TO DO?

•Stop transfusion

•Keep venous access open

•Treat symptoms – antihistamines are administered orally or intramuscularly

•Do a treatment reaction workup – patient with recurrent urticarial reaction – pretreated with antihistamines prior to transfusion

Red cell may damage as results from

•Improper storage – overheating or freezing

•Way of preparation – freezing without a cryoprotective agent

•Mechanical stress - cardiopulmonary bypass pumps or from roller pumps in the blood pump

•simultaneous administration or mixing of drug

•Hypotonic(5% dextrose in water) or hypertonic(50% dextrose in water) solutions

Causes hemolysis….

In this situation, the blood is hemolyzed before it is transfused to the patient.

Patient do not show serious complication, commonly asymptomatic hemoglobinuria.

They might accompany an immune hemolytic transfusion reaction or the infusion of bacterially contaminated blood.

WHAT TO DO?

Document the cause – if patient has experienced any hemolytic reaction

Fluid therapy and monitored for further sign and symptoms – if the transfusion initiate disseminated intravascular coagulation (DIC)

Prevention – adherence to the standards established preparation, storage and infusion of blood….