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Simulation Training Assessment Tool (STAT)– Acute Hemolytic Transfusion Reaction

Simulation Training Assessment Tool (STAT)– Acute Hemolytic Transfusion Reaction . Date: 27 MAR 13 . Instructor(s): . Learner(s): . Learning Objectives: 1. Recognize acute hemolytic transfusion reaction (AHTR) 2. Manage AHTR appropriately

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Simulation Training Assessment Tool (STAT)– Acute Hemolytic Transfusion Reaction

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  1. Simulation Training Assessment Tool (STAT)– Acute Hemolytic Transfusion Reaction Date: 27 MAR 13 Instructor(s): Learner(s): Learning Objectives: 1. Recognize acute hemolytic transfusion reaction (AHTR) 2. Manage AHTR appropriately 3. Respond appropriately to systemic error of wrong blood transfusion

  2. Admission Labs • WBC 6.5 • Hb 6.0 • Hct 18 • Plt 270 • Na 139 • K 5.0 • Cl 102 • HCO3 24 • BUN 25 • Cr 1.1 • Glu 105

  3. iSTAT • Na 140 • K 5.2 • Cl 100 • iCa 1.20 • TCO2 28 • Glu 105 • BUN 26 • Cr 1.3 • Hct 20 • Hb 6.5 • AnGap18 Hemolysis Labs • Coombs test + • Plasma free Hb 50 mg/dL • Ref range 1-4 mg/dL • Haptoglobin 0 • Ref range 5-20 mg/dL • LDH 1000 • 50-150 U/L • Urine hemoglobin +

  4. Acute hemolytic transfusion reaction • Results from infusion of incompatible RBCs • Transfused RBCs are destroyed by pre-formed antibodies • Usually anti-A or –B, but also anti-Rh, anti-Jka that are capable of fixing complement • Signs and symptoms include fever, chills, flank pain, hemoglobinuria, shortness of breath • May progress to shock, DIC, respiratory failure, ARF • NB– Delayed hemolytic transfusion reaction is an entity

  5. Acute hemolytic transfusion reaction Treatment Labs Free hemoglobinemia and hemoglobinuria Haptoglobinis decreased (binds to free hemoglobin) Coombs testing of pre- and post-transfusion blood Test for globulin antibodies on the surface of RBCs • Stop transfusion • Brisk hydration to avoid acute renal injury • Goal= UOP 100-200 cc/h • Vigorous supportive care while labs pending confirmation

  6. Febrile nonhemolytic transfusion reaction • Most common transfusion reaction • Manifests with fever and chills • May be hard to distinguish from early acute hemolytic reaction • Must stop transfusion and rule out hemolysis • Treat with antipyretics & antihistamine while labs are pending • No evidence to support pre-treatment • Caused by interleukin release from leukocytes • Leukoreduction is an effective preventive therapy • 40% of patients with one FNHTR will have another? • 75% of PRBC in US are pre-reduced

  7. Allergic Transfusion Reactions • Range from minor to anaphylaxis • Due to plasma protein incompatibilities • Erythema, urticaria, pruritus, bronchospasm, vasomotor instability • Reaction severity is not dose-related • Treat urticaria with antihistamines • Discontinuation of transfusion is not always required

  8. Delayed Transfusion Reactions • Delayed hemolytic transfusion reaction • Infections • Severe bacterial infection • Platelets 1:50,000 • PRBCs 1:500,000 • Risk of hepatitis B = 1:200,000 • Risk of hepatitis C or HIV = 1:2,000,000 • Risk of West Nile virus and Creutzfeldt-Jakob disease is unknown • Transfusion Related Acute Lung Injury (TRALI) • Pulmonary edema due to incompatibility of passively transferred leukocyte antibodies • 50% of transfusion related deaths • Other transfusion-related risks • Volume overload • Hypothermia

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