Questions and Answers
What characterizes a febrile nonhemolytic reaction?
Rise in temperature of ≥1⁰C beyond normal accompanied by chills or rigors.
Which of the following treatments is NOT typically required for febrile nonhemolytic reactions?
Transfusion-related acute lung injury (TRALI) can present with signs of cardiac failure.
False
What is a common symptom of transfusion-related acute lung injury (TRALI)?
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What imaging finding is associated with transfusion-related acute lung injury (TRALI)?
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Which type of patients are at highest risk for transfusion-associated graft-versus-host disease (TA-GVHD)?
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Symptoms of transfusion-associated graft-versus-host disease (TA-GVHD) can manifest within _ to _ days after transfusion.
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What is one of the absolute indications for irradiation of blood components?
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What occurs during transfusion-associated circulatory overload (TACO)?
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Transfusion-associated circulatory overload (TACO) typically presents with noncardiogenic pulmonary edema.
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Study Notes
Febrile Nonhemolytic Reaction (FNHTR)
- Characterized by a temperature rise of ≥1°C beyond normal, accompanied by chills or rigors.
- Caused by the accumulation of pyrogenic cytokines.
- Requires ruling out hemolytic transfusion reaction (HTR) or bacterial contamination.
- Typically self-limited and resolves within 2-3 hours; treatment is usually not required.
- Risk reduction strategies include filtration, plasma removal, washing blood components, and avoiding intravascular hemolysis when transfusing platelets.
- Less severe than acute hemolytic transfusion reactions (AHTRs) unless specific antibodies (anti-Rh, anti-Kell, anti-Kidd) are present.
- Laboratory findings: anemia, elevated lactate dehydrogenase (LD), hyperbilirubinemia, decreased haptoglobin, increased white blood cells (WBC), positive new RBC antibodies, and positive direct Coombs test (DAT).
- Suggested treatments include symptomatic relief, exchange transfusion for significant antigen-positive RBCs, and high-dose intravenous immunoglobulin (IVIG).
Transfusion-Related Acute Lung Injury (TRALI)
- Symptoms emerge during or shortly after transfusion of plasma-containing products, with no signs of cardiac failure.
- Results from antibodies in the donor’s plasma reacting against recipient HLA or granulocyte antigens, or lipid mediators activating recipient neutrophils.
- Clinical symptoms include dyspnea, hypoxemia, tachycardia, cyanosis, fever, and hypotension, without abnormal breath sounds.
- Chest X-ray (CXR) reveals non-cardiogenic pulmonary edema.
- Symptoms usually resolve within 48-96 hours, but CXR changes might last over a week without lasting pulmonary damage.
- Differential diagnoses include transfusion-associated circulatory overload (TACO), bacterial contamination, allergic reactions, ARDS, pulmonary embolism, and hemorrhage.
Transfusion-Associated Circulatory Overload (TACO)
- Manifests as congestive heart failure (CHF) during or shortly after transfusion.
- CXR shows pulmonary edema, particularly along major vasculature with elevated pulmonary capillary wedge pressure (PWP).
- Differential diagnosis includes TRALI, allergic reactions, and other CHF causes not related to transfusion.
- Increased risk for patients with preexisting heart conditions; strategies to prevent TACO include slow transfusion rates, transfusing small aliquots, plasma removal, and administering diuretics before or after transfusion.
Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)
- Occurs when viable donor T cells proliferate and attack the recipient's tissues, despite non-recognition by the recipient's immune system.
- Higher risk in patients with significant cellular immunodeficiency; patients with humoral immunodeficiencies (e.g., common variable immunodeficiency) are not at risk.
- Symptoms manifest within 2-50 days post-transfusion, indicating a rash, diarrhea, fever, liver dysfunction, and pancytopenia.
- Prevention strategies include irradiation of blood products and caution with transfusions from first or second degree relatives.
TA-GVHD: Indications for Irradiation of Blood Components
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Absolute Indications:
- Congenital cellular immunodeficiencies: DiGeorge syndrome, severe combined immunodeficiency (SCID).
- Immaturity of immune system: Intrauterine transfusions (IUTs), transfusions to neonates with IUT, very low birth weight (VLBW) infants.
- Disease-related immunodeficiencies: Hodgkin lymphoma (HL).
- Treatment-related immunodeficiencies: Post-hematopoietic progenitor cell transplantation, granulocyte transfusions, chemotherapy with purine analogs (e.g., fludarabine).
- Transfusions from biologic relatives (1st or 2nd degree).
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Probable Indications: Low birth weight infants.
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Description
Explore the details of febrile nonhemolytic transfusion reactions in this clinical pathology quiz. Understand the symptoms, causes, and management strategies for this common reaction. Assess your knowledge of blood transfusion practices and protocols.
