Mary Marsden & Carmel Parker. Transfusion Practitioners. Ext 68041 bleep 2010 or 8041

1. Mary Marsden & Carmel Parker. Transfusion Practitioners. Ext 68041 bleep 2010 or 8041

2. Reportable Incidents • Incorrect blood component transfused (IBCT) • Transfusion transmitted infection (TTI) • Immune complications • Transfusion-related acute lung injury (TRALI) • Acute transfusion reaction (ATR) - <24hrs • Febrile transfusion reactions • Delayed transfusion reaction (DHTR) - >24hrs • Transfusion-associated graft-versus-host-disease (TA- GVHD) • Post-transfusion purpura (PTP) • Transfusion Associated Circulatory Overload (TACO) • ‘Near Miss’ events

3. Signs and Symptoms of Haemolytic Reaction

4. Signs and Symptoms of a Delayed Reaction • Usually occur in patients who have developed antibodies in the past, from transfusion or pregnancy • These may be undetectable when the patient is tested • However when the patient receives a transfusion this can boost the production of antibodies

5. Delayed Reactions Fever and any other symptoms/signs of haemolysis more than 24 hours after transfusion Unexpected fall in Haemoglobin(Hb) May have postive Direct Antiglobulin test (Coombs’ test) or positive crossmatch Consider sending samples to the NHSBT

6. Transfusion Reactions Non-Haemolytic Febrile (Fever) Transfusion Reaction Between 1-2% of transfused patients experience some sort of febrile reaction Caused by antibodies in the patient’s plasma reacting against the leucocytes in the donors blood Blood has been leucodepleted since 1998

7. Signs and Symptoms • Fever or rigor 30 - 60 minutes after the start of the unit +/- rash • TREATMENT: • Stop the transfusion check the details on the blood bag match the patient • Give antipyretic e.g. Paracetamol +/- Piriton • Continue transfusion if symptoms subside

8. Transfusion Associated Graft Versus Host Disease (TA-GVHD) The donors blood (the graft) mounts an immune response against the (recipient) host No effective treatment The condition is nearly always fatal

9. Post Transfusion Purpura Definition Thrombocytopenia within 12 days after transfusion of red cells, associated with the presence in the patient of antibodies directed again the HPA systems. Need to exclude DIC Need to send blood for HPA typing and antibody screen

10. Post Transfusion Purpura Platelet antibodies from the donor destroy the recipient’s platelets These lowered platelet levels cause bleeding from the micro vessels into the skin and manifest as purple areas (purpura) on the patients skin

11. Infection Transmission Viral infections screened for at the time of donation Bacterial infections from contaminated blood components

12. Iron Overload • Each unit of blood contains 250 mg of iron • For patients on long term transfusion therapy this starts to accumulate and become toxic causing damage to the liver heart, pancreas and organs of the endocrine system • Drug therapy is given to excrete this excess

13. Consider TACO Fluid Overload Caused when too much fluid is transfused or the transfusion is too rapid Signs & Symptoms include Acute Left ventricular failure,dyspnoea, Hypotension, Tachycardia raised jugular venous pressure

14. Allergic Reactions • Signs & Symptoms can range from: • Mild and common (estimated risk 1 in100 • Urticaria (a raised red itching rash) Treated with • an antihisamine with the transfusion being • recommenced if the symptoms subside • To • Rare (estimated risk 1 in 500,000) • but very severe and sometimes fatal anaphylaxis • manifesting in:- low BP, laboured breathing, • oedema, respiratory & cardiac arrest

15. Transfusion Related Acute Lung Injury Caused by antibodies in the donors plasma reacting strongly with the patient’s leucocytes Signs & Symptoms Transfusion is followed by a rapid onset of breathlessness and non productive cough Chest x ray characteristically shows bilateral pulmonary infiltrates or ‘white out’

16. Transfusion Related Acute Lung Injury Acute dyspnoea with hypoxia and bilateral pulmonary infiltrates during or within 6 hours of transfusion Inform transfusion as soon as possible Treat as adult respiratory distress syndrome Need to inform the National Blood Service

17. What is it? What would you do?

18. Haemolytic Transfusion Reaction An Acute medical emergency Caused by ABO incompatible transfused red cells Probably due to misidentification of The patient The product or The sample Seek Haematology Input immediately

19. Ranges from • Asymptomatic • Haemolysis • Renal failure DIC • Death

20. Reporting Incidents/Transfusion Reactions Stop the Transfusion and seek Medical Input and inform the Transfusion Laboratory staff Check the Blood component matches the patient details Replace the unit and giving set with Normal Saline 0.9% Send the discontinued unit with giving set attached back to transfusion capped off at the end with a white venflon cap – and any previous transfused bags sealed with the blue plugs all in biohazard bags Documentation (complete the checklist) Complete a Trust Incident form

21. Conclusion • Transfusions of blood & blood components • are labour intensive & expensive but are • frequently life saving • In a few patients, however they can result in potentially fatal complications. • It is therefore essential that they are only given when the benefits outweigh the risks