blood transfusion reactions
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on Aug 21, 2012 Says :
Impressive PPT on Blood Transfusion Reactions.
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Slide 1 :
Blood Transfusion Reactions DR. NAVNEET TRIPATHI moderator: DR. BASANT KUMAR
Slide 2 :
Objective Early identification of common transfusion rxns. Differentiate life threatening reactions from benign transfusion rxns. Manage common immunologic rxns. SHOT trial (serious hazards of tranx) -most common cause is tranx of mis-matched blood mostly d/t to clerical error -2 x more common in infants than adults -more common in pxts with hematological and oncological conditions
Slide 3 :
Classification of Transfusion RXN Acute Delayed Immunologic Non-Immunologic Classical “Transfusion Reaction” refers to immunologic reactions between the inherited or acquired antibodies of RECIPIENT with antigens that are associated with the cellular or humoral components of the DONOR blood component.
Slide 4 :
Types of Reactions 1. Immune mediated transfusion reactions classic blood tranx rxns are usually immunologic and occur d/t to interactions of inherited/ acquired Ab with foreign Ag from transfused blood Febrile non hemolytic tranx rxns Immune mediated hemolysis ---Acute and delayed hemolytic reactions Anaphylactic transfusion rxns Urticarial transfusion rxns Post-transfusion purpura GVHD TRALI IMMUNOSUPPRESION
Slide 5 :
2. Non immune mediated reactions Volume overload Massive transfusion : hypothermia , pulmonary microembolism Chemical - citrate toxicity, hypo/hyperkalaemia, iron overload Acute hypotensive reaction: mediated by bradykinins Congenital and acquired hemolytic anemia
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3. INFECTIOUS Hepatitis B/C HIV , HTLV CMV, EBV, West Nile virus BACTERIAL : PSEUDOMONAS , YERSINIA ENTERCOLITICA SYPHILIS PARASITES : malaria,Chagas dx,
Slide 7 :
Febrile non hemolytic tranx rxn Most common reaction usually benign without sequelae Concerning because initial presentation is similar to more adverse rxns. i.e. fever, chills +/- mild dyspnea. 15% will have a rxn in the future with subsequent tranx Management -Discontinue transfusion -rule out hemolysis i.e. check labels, repeat type and cross, coombs test. -Antipyretics -Although antihistamine premedication is widely used there are no evidence to support that their use actually prevents rxn.
Slide 8 :
Acute hemolytic rxns Medical emergency Occur due to transfused RBC destruction by preformed recipients Abs Mostly d/t to ABO incompatibility-typically type O receiving non O blood. May occur with other blood types IgM mediated complement fixation leading to rapid intra vascular hemolysis Most common causes are clerical or procedural errors Complications includes DIC, shock, ARF d/t to ATN
Slide 9 :
Clinical presentation Classic presenting triad of Fever, flank pain and reddish brown urine from hemoglobinuria are rarely seen DIC may be presenting mode Labs Direct Coombs +, Pink plasma, FDP in DIC Management Stop transfusion, alert blood bank to start search for clerical error since another patient may be at risk R/o tranx rxn i.e. check labels, repeat type and cross with unit, check urine for hemoglobin Supportive care; ABC +/-vasopressors cardiac monitoring because of risk of hyperkalemia Infuse NS to maintain BP and promote diuresis, avoid RL and dextrose because calcium in RL will promote clotting in IV line and dextrose will increase hemolysis. Maintain urine output >100-200ml/hour With DIC early heparinization 10u/kg/hr
Slide 10 :
Transfusion related acute lung injury/ TRALI New acute lung injury occurring during or within 6 hour of blood product transfusion MC cause of transfusion related mortality - 1 case for every 1000-2400 units transfused - 6-9% mortality rate All blood products have been implicated May progress to ARDS Immune mediated non cardiogenic pulmonary edema Risk factors - prolonged storage of blood products, massive tranx, multiparity, thrombocytopenia and active infections have been implicated in a number of studies.
Slide 12 :
Management TRALI - -Mostly supportive with abrupt resolution in symptoms within a few days Majority of patients may require mechanical ventilation -Diuretics play no role in management since it is d/t microvascular damage and not d/t volume. It has been shown to actually worsen TRALI
Slide 13 :
“TAKE HOME MESSAGE” Transfusion reactions are mostly due to clerical errors and can range from benign reactions to life threatening emergencies Early detection, discontinuation of transfusion and instituting supportive care immediately are key to Mx. Reporting of all reactions helps to improve standard practices and reduce future occurrences.
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