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Questions and Answers
What characterizes an acute transfusion reaction?
What characterizes an acute transfusion reaction?
Which type of blood transfusion reaction occurs days or weeks after the transfusion?
Which type of blood transfusion reaction occurs days or weeks after the transfusion?
What is the primary cause of immune hemolysis in transfusion reactions?
What is the primary cause of immune hemolysis in transfusion reactions?
Which action is NOT part of the rapid management of a transfusion reaction?
Which action is NOT part of the rapid management of a transfusion reaction?
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What does a transfusion reaction require for proper evaluation?
What does a transfusion reaction require for proper evaluation?
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What is the significance of WHO guidelines regarding blood transfusion?
What is the significance of WHO guidelines regarding blood transfusion?
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What typically defines a non-immune transfusion reaction?
What typically defines a non-immune transfusion reaction?
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What is a critical factor in deciding whether to proceed with a blood transfusion?
What is a critical factor in deciding whether to proceed with a blood transfusion?
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What immediate action should be taken if a mild allergic reaction such as urticaria occurs during a transfusion?
What immediate action should be taken if a mild allergic reaction such as urticaria occurs during a transfusion?
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What is the most severe manifestation of a transfusion-related allergic reaction?
What is the most severe manifestation of a transfusion-related allergic reaction?
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What type of antibodies are primarily responsible for severe allergic reactions during transfusions?
What type of antibodies are primarily responsible for severe allergic reactions during transfusions?
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Which of the following reactions can occur due to donor plasma and recipient interaction?
Which of the following reactions can occur due to donor plasma and recipient interaction?
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What is a classic example of a severe allergic reaction in patients without IgA?
What is a classic example of a severe allergic reaction in patients without IgA?
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Which condition is characterized by respiratory distress and severe hypoxemia during or shortly after a transfusion?
Which condition is characterized by respiratory distress and severe hypoxemia during or shortly after a transfusion?
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What is the recommended treatment for severe allergic reactions during a transfusion?
What is the recommended treatment for severe allergic reactions during a transfusion?
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Which blood transfusion approach can help minimize allergic reactions, especially in patients with IgA deficiency?
Which blood transfusion approach can help minimize allergic reactions, especially in patients with IgA deficiency?
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What is the primary cause of transfusion-associated fatalities?
What is the primary cause of transfusion-associated fatalities?
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Which patient population is at an increased risk of developing TRALI?
Which patient population is at an increased risk of developing TRALI?
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Which clinical feature is characteristic of TRALI?
Which clinical feature is characteristic of TRALI?
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What is the most common supportive measure for managing TRALI?
What is the most common supportive measure for managing TRALI?
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What differentiates TACO from TRALI?
What differentiates TACO from TRALI?
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What symptom is NOT typically associated with TRALI?
What symptom is NOT typically associated with TRALI?
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During which time frame does TRALI most commonly present following a transfusion?
During which time frame does TRALI most commonly present following a transfusion?
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Which clinical sign indicates that the cardiovascular system's capacity is exceeded during a blood transfusion?
Which clinical sign indicates that the cardiovascular system's capacity is exceeded during a blood transfusion?
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What is a key indicator for diagnosing transfusion-associated sepsis?
What is a key indicator for diagnosing transfusion-associated sepsis?
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What symptom is characteristic of febrile nonhemolytic transfusion reaction (FNHTR)?
What symptom is characteristic of febrile nonhemolytic transfusion reaction (FNHTR)?
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Which of the following is NOT a preventive measure for transfusion-associated sepsis?
Which of the following is NOT a preventive measure for transfusion-associated sepsis?
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What immediate action should be taken if transfusion-associated sepsis is suspected?
What immediate action should be taken if transfusion-associated sepsis is suspected?
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Which complication is characterized by symptoms such as nausea, vomiting, and fever due to exposure to donor cytokines?
Which complication is characterized by symptoms such as nausea, vomiting, and fever due to exposure to donor cytokines?
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Which of the following is a possible cause of transfusion-associated sepsis?
Which of the following is a possible cause of transfusion-associated sepsis?
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What is the typical time frame for completing a red cell transfusion to minimize risks?
What is the typical time frame for completing a red cell transfusion to minimize risks?
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Which of the following is NOT a clinical feature associated with bacterial contamination in transfusions?
Which of the following is NOT a clinical feature associated with bacterial contamination in transfusions?
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What condition is characterized by pulmonary edema, cardiomegaly, and a distended pulmonary artery after blood transfusion?
What condition is characterized by pulmonary edema, cardiomegaly, and a distended pulmonary artery after blood transfusion?
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What is the consequence of human platelet antigen specificity in a blood transfusion?
What is the consequence of human platelet antigen specificity in a blood transfusion?
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What does DSHTR stand for in the context of transfusion reactions?
What does DSHTR stand for in the context of transfusion reactions?
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How is a delayed transfusion reaction defined?
How is a delayed transfusion reaction defined?
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What condition is characterized by marked thrombocytopenia 5-10 days after a platelet transfusion?
What condition is characterized by marked thrombocytopenia 5-10 days after a platelet transfusion?
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Which patients are at the highest risk of developing iron overload from red blood cell transfusions?
Which patients are at the highest risk of developing iron overload from red blood cell transfusions?
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Which of the following is NOT a type of delayed transfusion reaction?
Which of the following is NOT a type of delayed transfusion reaction?
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Which symptoms are commonly associated with delayed serologic/hemolytic transfusion reactions?
Which symptoms are commonly associated with delayed serologic/hemolytic transfusion reactions?
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How is iron overload related to red blood cell transfusions?
How is iron overload related to red blood cell transfusions?
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What treatment is effective in managing severe thrombocytopenia following a blood transfusion?
What treatment is effective in managing severe thrombocytopenia following a blood transfusion?
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What typically triggers a delayed serologic hemolytic transfusion reaction?
What typically triggers a delayed serologic hemolytic transfusion reaction?
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What method is critical for preventing iron overload in transfusion patients?
What method is critical for preventing iron overload in transfusion patients?
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What laboratory test is likely included in additional testing for delayed hemolytic reactions?
What laboratory test is likely included in additional testing for delayed hemolytic reactions?
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What clinical evidence might indicate shortened survival of transfused cells?
What clinical evidence might indicate shortened survival of transfused cells?
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What are the potential organs affected by iron overload due to multiple red blood cell transfusions?
What are the potential organs affected by iron overload due to multiple red blood cell transfusions?
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Why are patients who have had multiple pregnancies more susceptible to certain transfusion reactions?
Why are patients who have had multiple pregnancies more susceptible to certain transfusion reactions?
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Study Notes
Adverse Effects of Blood Transfusion
- Blood transfusion is an essential part of modern healthcare but carries potential risks for recipients. It should only be prescribed for conditions with significant morbidity or mortality, where other means of treatment aren't effective.
Objectives
- Differentiate the clinical signs and symptoms of acute and delayed transfusion reactions.
- Rapid management of transfusion reactions is crucial, especially during acute reactions, to save the patient's life.
- Understanding the procedures to follow in the event of a suspected transfusion reaction.
Types of Transfusion Reactions
- Immune reactions: Occur during or within hours of transfusion.
- Non-immune reactions: Can occur during or weeks after transfusion.
- Immediate reactions: Occur during or within hours of transfusion.
- Delayed reactions: Occur days or weeks after transfusion.
Classification of Transfusion Reactions
- Acute transfusion reaction: Presents with signs or symptoms within 24 hours of transfusion.
- Delayed transfusion reaction: Presents with signs or symptoms after 24 hours of transfusion.
- Immune vs. non-immune: Further classification based on whether the reaction is antibody-mediated.
Immune Hemolysis
- Immune hemolysis occurs when previously formed IgM (ABO) or IgG antibodies in the recipient recognize donor RBC antigens, resulting in complement-mediated intravascular hemolysis.
- Further testing (e.g., repeat immunohematology testing, eluate, antigen typing) may be needed to identify the cause.
Non-immune Hemolysis
- Non-immune hemolysis happens due to mechanical or chemical damage to RBCs, leading to asymptomatic hemoglobinuria.
Immune Transfusion Reactions
- Recipient antibodies against donor antigens (e.g., red blood cells, white blood cells, platelets).
- Reaction to plasma proteins.
Acute Transfusion Reactions
- Fever, allergic reactions, pulmonary reactions (e.g., TACO, TRALI) are categorized by presenting symptoms.
Hemolytic Transfusion Reactions (Acute)
- Increased destruction of donor red blood cells.
- Intravascular hemolysis (ABO incompatibility often due to activation of complement cascade).
- Extravascular hemolysis (Rh or minor group incompatibility; IgG/C3d-coated cells removed in reticuloendothelial system).
Acute Hemolytic Transfusion Reaction (AHTR)
- Acute hemolysis (rapid destruction of red blood cells) occurs within 24 hours of transfusion.
- The cause may be immune- or non-immune-related.
- Immune-mediated reactions can include acute hemolytic reactions, transfusion-associated sepsis, febrile non-hemolytic reactions, allergic reactions, TRALI, and TACO.
Causes of Acute Haemolysis
- Red cell incompatibility (ABO incompatibility).
- Accidental heating or freezing of red blood cells (RBCs).
- RBCs in contact with water or 5% dextrose.
- Bacterial contamination.
- Administering RBCs through a small-gauge needle.
ABO Incompatible Transfusion Reactions
- Usually due to misidentification of the patient or recipient.
- The most common cause is clerical errors (in unconscious or anesthetized patients).
- Wrong blood samples, blood packs, grouping, or cross-matching errors.
Clinical Features (Symptoms and Signs of Reactions)
- Includes symptoms like chills, chest/back pain, headache, itching, palpitation, dyspnea, nausea, vomiting, and hemoglobinuria.
- Signs include fever, rigors, flushing, restlessness, hypotension, tachycardia, and urticaria.
Management of AHTR
- Immediately stop the transfusion.
- Maintain an IV line.
- Provide cardio-respiratory support.
- Maintain blood pressure, heart rate, and airway.
- Ensure diuresis and collect first urine sample for hemoglobinuria.
- Check patient identification and blood pack.
- Give supportive therapy (oxygen, elevate the foot end).
- Treat DIC (heparin), renal failure (dopamine).
- Report the reaction immediately.
- Record: reaction type, time, volume, unit number.
- Send post-transfusion samples (blood, remaining blood pack with filled forms) to the blood bank.
- Monitor blood urea and creatinine levels.
- Perform coagulation screen to rule out DIC.
Transfusion-Associated Sepsis
- Due to contamination of blood components (especially platelets) during collection, processing, or storage in the blood bank/ward.
- Possible sources are bacteremia in donor and endotoxins.
- Presents with clinical features such as high-grade fever, nausea/vomiting, abdominal cramps, shock, and disseminated intravascular coagulation (DIC).
Management of TAS
- Stop the transfusion immediately.
- Examine the blood pack for visible changes.
- Start intravenous line.
- Provide broad-spectrum antibiotics.
- Monitor vital signs (including blood cultures from the blood pack, tubing, and recipient).
- Maintain supportive treatment.
Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
- Caused by recipient antibodies against donor white blood cells or platelets, or presence of cytokines in donor blood components.
- Presents with a temperature increase of at least 1°C (with or without chills) within 30 minutes of transfusion discontinuation.
- Symptoms include fever, chills, rigors, nausea, vomiting, hypotension, shock.
Management of FNHTR
- If mild: slow down the transfusion rate, administer antipyretics.
- If severe: stop the transfusion, administer antipyretics, symptomatic treatment.
- Consider leucoreduced/leucodepleted blood components and antipyretic cover/slow transfusion for prevention.
Allergic Transfusion Reactions
- Result from recipient antibodies against allergens present in blood components.
- Ranges from mild urticaria to severe anaphylactoid reactions, including bronchospasm, respiratory distress, circulatory collapse, hypotension, and shock.
- Occur due to plasma protein contamination in blood components.
Management of Allergic Reactions
- Mild: slow down the transfusion rate, administer antihistamines.
- Severe/anaphylactoid: stop the transfusion, administer epinephrine, provide supportive care (e.g., oxygen, maintain blood pressure)
- Use washed blood. Consider an antihistamine cover/slow transfusion/autologous blood transfusion to prevent repeated reactions in those with IgA deficiency.
Transfusion-Related Acute Lung Injury (TRALI)
- Acute lung injury presenting with respiratory distress and hypoxemia within 6 hours of transfusion.
- Usually caused by recipient antibodies against donor leukocytes, resulting in leukocyte aggregation and pulmonary microvascular damage and vascular permeability.
- Symptoms: acute respiratory distress, fever with chills, non-productive cough, chest pain, bilateral pulmonary edema, bilateral pulmonary infiltrates on chest X-ray, cyanosis, and hypotension.
Management of TRALI
- Supportive care (respiratory support with oxygen, mechanical ventilation, steroids).
- No specific treatment is available. Clinicians need to promptly recognize and manage TRALI.
Transfusion-Associated Circulatory Overload (TACO)
- Acute, non-immune complication presenting with respiratory distress and hypoxemia.
- Results from exceeding the patient's cardiovascular system's capacity to handle the transfused blood volume.
- Symptoms include cough, headache, chest discomfort, hypertension, jugular venous distention, elevated central venous and pulmonary wedge pressures.
Delayed Transfusion Reactions
- Reactions that occur 24 hours or more after a transfusion, encompassing a wide range of etiologies.
- Serologic/hemolytic reactions
- Transfusion-associated graft-versus-host disease (TAGVHD)
- Post-transfusion purpura (PTP)
- Iron overload
Post-Transfusion Purpura (PTP)
- Delayed immune-related complication (1-24 days post-transfusion).
- Typically caused by anamnestic response of the recipient to a transfused human platelet antigen to which the patient was previously exposed.
- Characterized by a marked drop in platelets (thrombocytopenia)
- Treatment usually involves therapeutic plasma exchange or intravenous immunoglobulin. Platelet transfusions are generally ineffective.
Iron Overload
- Delayed, non-immune complication from multiple red blood cell (RBC) transfusions.
- Chronic RBC transfusions lead to iron accumulation in the liver, heart and endocrine organs, causing damage.
- Symptoms vary but typically result in multi-organ damage.
Prevention of Transfusion Reactions
- Aseptic collection and processing.
- Proper storage and transportation.
- Start transfusion within 30 minutes of receiving product.
- Complete Red cell transfusion within 4 hours to reduce risks.
- Avoid unnecessary blood warming.
- Change transfusion sets every 24 hours.
- Avoid clerical errors by carefully identifying both the patient and the blood pack.
- Carefully observe the patient undergoing transfusion.
- Correct labeling of the blood samples.
- Avoiding unnecessary blood transfusions if not medically necessary.
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Description
This quiz focuses on the adverse effects associated with blood transfusions, essential in modern healthcare. Participants will learn about the distinctions between acute and delayed transfusion reactions and the importance of rapid management to ensure patient safety.
