Term
| General examples of Transfusion reactions |
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Definition
• Hemolytic Reactions – include acute and delayed reactions; ABO/Rh incompatibility
• Febrile non-hemolytic reaction – mild inflammatory response elicited from cytokines / leukocyte Ig’s
• Allergic (urticarial) & anaphylactic reactions – allergic reactions to/from donor blood
• Bacterial contamination – nonsterile equipment; donor skin/blood bacteria; platelet x-fusion (room temp)
• Transfusion-related acute lung injury – due to platelet activation/HLA reaction, causes pulm. edema
• Transfusion-associated circulatory overload – simulates CHF
• Post-transfusion purpura – clots?
• Graft vs. Host Disease – transfused T-cells are engrafted, attack host |
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Term
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Definition
| usually ABO incompatibility; presentation <24 hrs, has intravascular hemolysis |
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Term
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Definition
| – usually Rh incompatibility; presentation >24hrs, has extravascular hemolysis |
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Term
| Intravascular acute presentation |
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Definition
fevers/chills, pain @ infusion site, hemoglobinemia/-uria, dyspnea, vomiting, shock
Complications – leads to DIC, renal failure, ARDS, death
Mortality – about 10% |
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Term
| o Extravascular (delayed) presentation |
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Definition
fevers/chills, leukocytosis, anemia
Complications – leads to DIC, renal failure, sickle cell crisis (can be severe)
Mortality - rare |
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Term
| signs in anesthetized px of HTR |
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Definition
| o Bleeding + Hemoglobinuria |
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Term
most common cause of a HTR!
and other causes:... |
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Definition
Misidentification
Can be detected through free serum hemoglobin, positive DAT
o Positive DAT – RBCs coated with antibodies, thus bad transfusion
o New RBC antibody – new Ig developed against antigen |
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Term
| Febrile Non-Hemolytic Transfusion Reaction mechanisms: (2) |
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Definition
o Leukocyte antibodies in recipient – host reacts to leukocytes of blood transfusion; doesn’t happen often b/c WBCs filtered out
o Cytokine release – when blood is stored, some cytokines (IL-1, IL-6, CD40L) are released into blood bag |
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Term
| Allergic Transfusion Reaction mechanism |
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Definition
antibody to allergens/plasma proteins in donor blood; or passive transfer of donor IgE’s
• Presentation – looks like allergic reaction hives, flushing, dyspnea, vomiting
• Incidence – about 1-3% of transfusions |
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Term
| QUIZ: Anaphylactic Transfusion Reaction mechanism |
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Definition
generally when recipient has no IgA, and transfusion elicits anti-IgA response of recipient
o Haptoglobin – also can happen if recipient has no haptoglobin anti-haptoglobin response (Japan)
• Presentation – patient has anaphylactic reaction: bronchospasm, hypotension, stridor, shock
• Preventation – make sure to transfuse IgA-deficient plasma, and wash RBCs/platelets |
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Term
| Bacterial contamination: why the risk? what organisms, sources, presentation, Dx, and Tx? |
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Definition
• Platelet Transfusion – since stored at room temperature, higher risk for bacterial contamination
• Organisms – platelet transfusions have wide variety (Gram – rods, Gram + cocci), RBC = pseudomonas, Yersinia
• Sources – from nonsterile blood donation, or bacteria on donor skin/blood
• Presentation – has fevers/chills, rigors, hypotension, shock, DIC looks like HTR or sepsis
• Dx – do a Gram stain, cell culture
• Treatment – initial broad spectrum abx until culture results come back |
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Term
| Transfusion-Associated Circulatory Overload Mechanism/Presentation, Risk groups, mortality, ddx, prevention. |
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Definition
• Mechanism/Presentation – presents same way CHF presents dyspnea, hypoxemia, pulmonary edema
• Risk Groups – patients with heart disease, renal failure
• Mortality – will double underlying disease mortality
• DDx – includes HTR, allergic, TRALI, cardiac/pulmonary disease
• Prevention – slower infusions |
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Term
| TA Grafts vs host Mechanism, presentation, incidence, risk groups, ddx, tx |
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Definition
• Mechanism – transfused T-cells are engrafted & launch immune response against host
• Presentation – patient has rash, fever, diarrhea, liver dysfunction, cytopenia
• Incidence – very rare, but very lethal
• Risk Groups – patients with severe cellular immunodeficiency:
o Congenital immunodeficiencies – SCID, etc
o Intrauterine transfusion – fetus doesn’t yet have a developed immune system
o Bone marrow transplantation – patient is very immunosuppressed
o Acquired Immunodeficiency – hodgkin’s, high dose chemotherapy, NHL
• Homogenous populations/families – also risk, when donor recognizes host as foreign, but not vice-versa
• DDx – viral infection, drug reaction
• Tx – attempt to gamma irradiate T-cells, but difficult |
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Term
| Transfusion-Related Acute Lung Injury (TRALI) Mechanism , pres, mortality, ddx, prevention |
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Definition
• Mechanism – several key mechanisms:
o Donor antibodies to HLA/HNA antigens – can cause TRALI by releasing vasoactive substances
o Platelet problems in storage – producing platelet activating factor-like lipid, or CD40L release
• Presentation – non-cardiogenic pulmonary edema
• Mortality – 10-20%
• DDx – includes HTR, allergic reaction, fluid overload, acute lung injury
• Prevention – use plasma components from male donors; (use female donors for concentrates…)
o Pregnant women – likely to have HLA/HNA antibodies, since passive transfer from neonate
o Mother-to-child blood donation – not good, this is precisely what mom produced Ig’s against
o Antibody screening |
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Term
| Hep B - jaundice, % carriers, % of carriers => active |
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Definition
• Jaundice – presents 2-3 months after transfusion
• Carrier – of patients receiving Hep B through transfusion 5-10% become carriers
• Active – of 5-10% carriers, about 25% of carriers have active hepatitis B cirrhosis, hepatocellular carcinoma |
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Term
| Hep C - Sx, complications, prevalance |
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Definition
• Sx – patients receiving Hep C through transfusion usually nonicteric (not jaundiced), no acute infection
• Complications – although usually no infection, high risk chronic hepatitis (70%)
o Cirrhosis – of those w/ hepatitis, 10-20% later develop cirrhosis
• Prevalence – about 0.5% of 1st-time blood donors are HCV+
• Screening – now that screenings in place, HCV transfusion less; but still 10% prevalent based on past
• Sx – patients receiving Hep C through transfusion usually nonicteric (not jaundiced), no acute infection
• Complications – although usually no infection, high risk chronic hepatitis (70%)
o Cirrhosis – of those w/ hepatitis, 10-20% later develop cirrhosis
• Prevalence – about 0.5% of 1st-time blood donors are HCV+
• Screening – now that screenings in place, HCV transfusion less; but still 10% prevalent based on past |
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Term
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Definition
• Cytomegalovirus – an enveloped DNA herpes virus
• Prevalence – quite high in donor populations
• Sx – usually asymptomatic in immunocompetent patients, latent in monocytes
• Risk Groups – those who are immnunocompromised – fetus, premies, bone marrow x-plant, HIV
• Prevention – can either screen for CMV+ individuals, or just remove CMV from blood by filtering out monocytes |
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Term
| parvovirus associated problems: |
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Definition
• Parvovirus – a non-lipid enveloped DNA virus
• Clinical Sx – can be associated w/ erythema infectiosum (5th disease), arthritis, RBC bone marrow prob
o Bone marrow shutdown – if patient w/ accelerated hematopoiesis RBC aplasia, hydrops
o Non-immune hydrops – if transferred in utero, leads to immune cell destruction fatal
• Prevalence – about 1:1000-1:5000, found in plasma/factor concentrates (still not filtered out yet)
• Seroconversion rate – about 80%, thus will spread easily |
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Term
| West Nile Virus - latent period, prevalance, chronic carrier state? |
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Definition
• West Nile Virus – USA used to have blood x-fusion risk higher than background risk
• No chronic carrier state – those w/ antibodies don’t still carry disease
• Latent Period – 3-15 day latent period, before acute viral symptoms in 1:150 individuals
• Prevalence – about 1:10,000 blood donors, transfusion risk 1:1,000,000 b/c screened for w/ DNA testing |
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Term
| Chagas disease - what kind of infectious disease? who has it more? |
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Definition
• Chagas Disease – tropical parasite disease, rare but usually in Hispanic population
• Prevalence – very low, but in high foreigner areas more prevalent 1:5000 Los Angeles
• Infection – 60% of seropositive blood (antibody +) is PCR positive (disease present)
• Transmission – 7 cases in US & Canada; prevent through screening, leukocyte reduction |
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