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30/11/2549. MD-3 /49. 2. Transfusion Reaction. is any unfavorable transfusion-related event occurring in a patient during or after transfusion of blood components . 30/11/2549. MD-3 /49. 3. Immediate and Delayed Transfusion Reaction. 30/11/2549. MD-3 /49. 4. . . Acute Hemolytic Transfusion Reaction .
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2. 30/11/2549 MD-3 /49 2 Transfusion Reaction is any unfavorable transfusion-related event occurring in a patient during or after transfusion of blood components
3. 30/11/2549 MD-3 /49 3 Immediate and Delayed Transfusion Reaction
4. 30/11/2549 MD-3 /49 4
5. 30/11/2549 MD-3 /49 5 Signs and Symptoms of AHTR Chills , fever
Facial flushing
Hypotension
Renal failure
DIC
Chest pain
Dyspnea
Generalized bleeding
Hemoglobinemia
Hemoglobinuria
Shock
Nausea
Vomitting
Back pain
Pain along infusion vein
6. 30/11/2549 MD-3 /49 6 Acute Hemolytic Transfusion Reactions
7. 30/11/2549 MD-3 /49 7 Pathophysiology
Two mechanisms for RBCs destruction
1) Intravascular hemolysis
2) Extravascular hemolysis
8. 30/11/2549 MD-3 /49 8 Management of AHTR Stop the transfusion
Keep IV fluid
Notify patients physician and blood bank
Take care of patient
Perform bedside clerical checks
Return unit, set to blood bank
Collect appropriated post transfusion blood
sample for evaluation
Document reaction
9. 30/11/2549 MD-3 /49 9 Laboratory investigation for AHTR sample from blood bag Repeat ABO, Rh, Ab screening
Patient sample
Pre Tx sample Repeat ABO, Rh, Ab screening
Post Tx sample Repeat ABO, Rh, Ab screening, DAT,
CBC, UA, Bilirubin, BUN, Cr,
Coagulation screening
Repeat compatibility test
- Pre Tx sample & Donor unit
- Post Tx sample & Donor unit
10. 30/11/2549 MD-3 /49 10 Treatment of AHTR Depends on
Amount of incompatible blood
transfused
Specificity of the offending antibody
Clinical severity of the reaction
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15. 30/11/2549 MD-3 /49 15 Delayed Hemolytic Transfusion Reaction Most often the result of an anamnestic response (transfusion, pregnancy, transplantation )
Mild clinical signs and symptoms
Unexpected or unexplained decreased in Hb or Hct after transfusion should be investigate as possible DHTR
16. 30/11/2549 MD-3 /49 16 Delayed Hemolytic Transfusion Reaction Pathophysiology
- 2 types of DHTR
1) secondary (anamnestic) response to transfused RBCs ?3 7 day after Tx
2) primary alloimmunization longer
- Extravascular hemolysis
sensitized RBCs ? removed by RES
17. 30/11/2549 MD-3 /49 17 Delayed Hemolytic Transfusion Reaction Signs & Symptoms
mild fever or fever with chill
mild anemia
mild to moderate jaundice
Uncommon ? hemoglobinemia, Hemoglobinuria, shock, renal failure
18. 30/11/2549 MD-3 /49 18 Delayed Hemolytic Transfusion Reaction Therapy and Prevention
- Goal of therapy is prevention
- Treat severe complication if necessary
- Alert to history of sensitization
(previous transfusion, Pregnancy, transplantation)
19. 30/11/2549 MD-3 /49 19 Febrile Nonhemolytic Transfusion Reaction( FNHTR) Definition
1oC temperature rise associated with transfusion, no medical explanation other than blood transfusion
20. 30/11/2549 MD-3 /49 20 Pathophysiology of FNHTR - Patients
Leukocyte antibodies
(HLA Ab)
- Blood donors
leukocytes in transfused blood
21. 30/11/2549 MD-3 /49 21 Febrile Nonhemolytic Transfusion Reaction Signs & Symptoms
Fever with or without chills
most symptoms are mild
severe reaction :- hypotension, cyanosis, tachycardia, tachypnea, dyspnea, cough etc.
22. 30/11/2549 MD-3 /49 22
23. 30/11/2549 MD-3 /49 23 Allergic Transfusion Reactions Probably the most frequent kind of reaction
Pathophysiology
Allergen Reagin (IgE,IgG)
complex
attach mast cell
histamine/leukotrienes
Allergic reactions
(urticaria)
24. 30/11/2549 MD-3 /49 24 Allergic Transfusion Reactions Signs & Symptoms
- Urticaria
- severe reactions are rare
Therapy & Prevention
- Antihistamine
- Plasma deficient blood components
25. 30/11/2549 MD-3 /49 25 Anaphylactic and Anaphylactoid reactions Anaphylaxis can range from
mild urticaria to severe shock and death
Pathophysiology
- IgE antibody to IgA in donor plasma
(anti-IgA antibodies)
26. 30/11/2549 MD-3 /49 26 Anaphylactic and Anaphylactoid reactions Signs & Symptoms
- Anaphylactic ? coughing, dyspnea, nausea, emesis, bronchospasm, flushing of skin, chest pain, hypotension, abdominal cramps, diarrhea, shock, and death.
- Anaphylactoid (less severe) ? urticaria, periorbital swelling, dyspnea, or perilaryngeal edema
27. 30/11/2549 MD-3 /49 27 Anaphylactic and Anaphylactoid reactions Therapy and Prevention
Stop transfusion
Keep IV line open
Medication :- epinephrine, corticosteroid
Wash RBCs and blood components
Transfuse IgA deficiency blood
28. 30/11/2549 MD-3 /49 28 Transfusion-related Acute Lung Injury (TRALI) Pathophysiology
Leukocyte Ab in donor react with pt. leukocytes
Activate complements
Adherence of granulocytes to pulmonary endothelium with release of proteolytic enz.& toxic O2 metabolites
Endothelial damage
Interstitial edema and fluid in alveoli
29. 30/11/2549 MD-3 /49 29 Transfusion-related Acute Lung Injury (TRALI) Acute and severe type of transfusion reaction
Symptoms and signs
Fever
Hypotension
Tachypnea
Dyspnea
Diffuse pulmonary infiltration on X-rays
Clinical of noncardiogenic pumonary edema
30. 30/11/2549 MD-3 /49 30 Transfusion-related Acute Lung Injury (TRALI) Therapy and Prevention
Adequate respiratory and hemodynamic supportive treatment
If TRALI is caused by pt. Ab ? use LPB
If TRALI is caused by donor Ab ?no special blood components
31. 30/11/2549 MD-3 /49 31 Transfusion-associated Circulatory Overload (TACO) Patients at significant risk
Children
Elderly patients
Chronic anemia
Cardiac disease
Thalassemia major or Sickle cell disease
32. 30/11/2549 MD-3 /49 32 Pathophysiology
33. 30/11/2549 MD-3 /49 33 Symptoms and Signs Dyspnea
Coughing
Cyanosis
Orthopnea
Chest discomfort Headache
Restlessness
Tachycardia
Systolic hypertension increase > 50 mm.Hg
34. 30/11/2549 MD-3 /49 34 Therapy & Prevention Rapid reduction of hypervolemia
Respiratory and cardiac support
Oxygen therapy
Diuretic
Therapeutic phlebotomy
- Use appropiate transfusion rate
- Use appropiate blood components
35. 30/11/2549 MD-3 /49 35 Metabolic Reaction Citrate toxicity
Hyperkalemia
Hypothermia
Coagulopathy in massive transfusion
Air embolism
36. 30/11/2549 MD-3 /49 36 Transfusion-associated Graft-versus-Host Disease ( TA-GVHD) Patient at risk
37. 30/11/2549 MD-3 /49 37 Transfusion-associated Graft-versus-Host Disease ( TA-GVHD) Pathophysiology
Infusion of Immunocompetent Cells
(Lymphocyte)
Patient at risk
proliferation of donor T lymphocytes
attack against patient tissue
38. 30/11/2549 MD-3 /49 38 Graft-versus-Host Reaction Signs & Symptoms
39. 30/11/2549 MD-3 /49 39 Graft-versus-Host Reaction Therapy
40. 30/11/2549 MD-3 /49 40 Iron overload
41. 30/11/2549 MD-3 /49 41 Posttransfusion Hemosiderosis Affected organ :- heart, liver, endocrine glands
Signs & Symptoms
- muscle weakness, fatigue, weight loss, mild jaundice, anemia, mild diabetes, and cardiac arrhythmia
Therapy ? Iron chelating agent
Prevention ? transfuse with young RBCs
42. 30/11/2549 MD-3 /49 42 Alloimmunization Result from prior exposure to donor blood components
Significant complication ?even small amount of blood
Adverse effects may include
difficulty in finding compatible blood
transfusion reaction
platelet refractoriness
43. 30/11/2549 MD-3 /49 43 Alloimmunization Pathophysiology
1st exposure ? moderate production IgM and IgG antibody by foreign antigens
2nd exposure ? rapid production of large amount of IgG
44. 30/11/2549 MD-3 /49 44 Alloimmunization Signs & Symptoms
mild ? slight fever and Hb
severe ? platelet refractoriness with bleeding
Therapy & Prevention
depends on type and severity
45. 30/11/2549 MD-3 /49 45 Posttransfusion Purpura Rare complication
Rapid onset of thrombocytopenia as a result of anamnestic production of platelet alloantibody
Usually occurs in multiparous woman
46. 30/11/2549 MD-3 /49 46 Posttransfusion Purpura Pathophysiology
Platelet Ab (anti-PLA1) ?attach platelet surface ? destruction by RES
Signs & Symptoms
Purpura and thrombocytopenia occur
~ 1 2 weeks after transfusion
47. 30/11/2549 MD-3 /49 47 Posttransfusion Purpura Therapy and Prevention
Corticosteroids
Exchange transfusion
Plasmapheresis
48. 30/11/2549 MD-3 /49 48 Bacterial contamination reaction Cause gram ve, gram +ve bacteria
most frequent Yersinia enterocolitica
Pathophysiology
Bacteria growing in cold temperature
Produced endotoxin
49. 30/11/2549 MD-3 /49 49 Symptoms & Signs Acute onset within ~ 30 min after transfusion
Dryness and flushing skin
Fever, hypotension, shaking chills, muscle pain, vomitting, abdominal cramps, bloody diarrhea, hemoglobinuria, shock, renal failure, and DIC.
50. 30/11/2549 MD-3 /49 50 Therapy & Prevention Broad spectrum antibiotics
Symptomatic treatment
Prevention
Phlebotomy and blood components preparation & processing , thawing by sterile technique.
51. 30/11/2549 MD-3 /49 51 Transfusion Transmitted Diseases Viral Infections
Hepatitis Viruses :- HBV, HCV
Retroviruses :- HIV
Herpesviruses :- CMV, EBV
Parvovirus :- Human B19 parvovirus
Prion :- infectious particle of CJD
52. 30/11/2549 MD-3 /49 52 Transfusion Transmitted Diseases Bacterial Infection
Gram negative and positive
Syphilis
Lyme disease (Borrellosis)
53. 30/11/2549 MD-3 /49 53 Transfusion Transmitted Diseases Parasitic Infections
Malaria
Chagas disease
Toxoplasmosis
Leishmaniasis
54. 30/11/2549 MD-3 /49 54 Serological Testingfor Infectious markers HIV Ag
Anti HIV
HBsAg
Anti HCV
Test for syphilis
55. 30/11/2549 MD-3 /49 55 Steps to take when a transfusion reaction occurs Stop the transfusion immediately
Leave the needle in the vein and begin infusing normal saline
Obtain vital signs
Begin O2 if pulmonary symptoms are prominent
Carry out PE : lung, heart, skin, signs of abnormal bleeding
56. 30/11/2549 MD-3 /49 56 Steps to take when a transfusion reaction occurs Obtain a new blood sample for repeat RBC compatibility test and inspection for hemolysis
Obtain a urine sample if the patient can void
Obtain a chest x-ray if pulmonary symptom are prominent
Make a preliminary assesment of the situation
Begin definitive treatment
57. 30/11/2549 MD-3 /49 57 TAKE CAREYOUR PATIENTSWITHBLOOD TRANSFUSION