Transfusion Reactions Quiz

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Questions and Answers

What clinical signs are typically associated with Transfusion Associated Circulatory Overload (TACO)?

Hypotension and bradycardia

Tachycardia and respiratory distress (correct)

Fever and platelet dysfunction

Hemolytic reactions and shock

Which of the following populations is at greater risk for TACO?

Young adults in good health

Patients receiving elective surgeries

Patients with diabetes

Children and those over 60 (correct)

What is the immediate action required by the Blood Transfusion Laboratory upon suspicion of a transfusion reaction?

Re-initiate the transfusion at a slower rate

Continue monitoring the patient

Stop the transfusion and contact the laboratory (correct)

Administer additional blood products immediately

Which test is NOT part of the post-transfusion sample evaluation?

Haptoglobin level in serum Signup and view all the answers

In the context of diagnosing adverse transfusion reactions, what does the acronym SABRE stand for?

Serious Adverse Blood Reactions and Events Signup and view all the answers

What is one of the main purposes of cross-matching?

To ensure compatibility between a unit of blood and the patient Signup and view all the answers

Which factors are required on a blood request form?

Patient's location and sample date Signup and view all the answers

What does an electronic cross-match require for successful completion?

ABO and Rh D group to match the historical record Signup and view all the answers

What is the incubation temperature and time required during the immediate spin cross-matching process?

37 °C for 15 minutes Signup and view all the answers

What characterizes an acute transfusion reaction?

Occurs within 30-60 minutes after transfusion Signup and view all the answers

What is a common symptom of acute haemolytic reaction?

Fever and chills Signup and view all the answers

What is a typical symptom of Transfusion Related Acute Lung Injury (TRALI)?

Acute respiratory distress Signup and view all the answers

Which statement is true regarding delayed transfusion reactions?

They can occur weeks after the transfusion. Signup and view all the answers

Which of the following is NOT included in the criteria for electronic cross-matching?

Manual amendments to the record Signup and view all the answers

Which type of allergic reaction is associated with an IgE mediated immune response?

Anaphylactic shock Signup and view all the answers

How long does cross-matching usually take?

35-40 minutes Signup and view all the answers

What is a common cause of bacterial infections in transfusions?

Contamination during blood collection and processing Signup and view all the answers

Which of the following is NOT a type of transfusion reaction?

Autoimmune hemolytic anemia Signup and view all the answers

In which situation should a transfusion be immediately stopped?

Upon signs of an acute transfusion reaction Signup and view all the answers

What is a major factor contributing to early transfusion reactions?

Presence of antibodies in the patient's serum Signup and view all the answers

How is Transfusion Related Acute Lung Injury (TRALI) typically diagnosed?

By excluding other acute conditions Signup and view all the answers

What is the primary purpose of cross-matching in blood transfusions?

To ensure compatibility between donor and recipient Signup and view all the answers

How many major antigens are present in the ABO blood group system?

4 Signup and view all the answers

Which of the following statements is true about Landsteiner’s Law?

If a blood group antigen is present, the corresponding antibody is absent Signup and view all the answers

What is the inheritance pattern of ABO blood group antigens?

Autosomal dominant Signup and view all the answers

Which of the following blood group systems has the highest number of major antigens?

MNS Signup and view all the answers

What is the minimum requirement for sample labeling in blood transfusion preparation?

Full name and minimum identifiers Signup and view all the answers

Which of the following blood group systems includes antigens such as Lea and Leb?

Lewis Signup and view all the answers

What defines the ABO blood group system compared to others regarding antibodies?

Antibodies are predictably present depending on antigen presence Signup and view all the answers

What key aspect should the blood transfusion laboratory focus on to enhance patient safety?

Collecting data and making recommendations Signup and view all the answers

Which type of transfusion reaction occurs immediately after the transfusion starts?

Acute Transfusion Reaction Signup and view all the answers

What was the primary error in Case Study 1 regarding the blood transfusion?

Pre-administration checks were not completed Signup and view all the answers

In Case Study 2, what issue was identified regarding the erythrocytes that were returned to the laboratory?

Communication with colleagues was poor Signup and view all the answers

What was the consequence of Patient B receiving the incorrect transfusion in Case Study 3?

Acute haemolytic reaction occurred Signup and view all the answers

What is one of the serious implications mentioned regarding incorrect blood transfusions?

They can lead to high morbidity rates Signup and view all the answers

What protocol should be ensured to prevent errors in blood transfusion procedures?

Strict pre-administration checks Signup and view all the answers

What could be a potential error related to blood storage in Case Study 2?

Time out of controlled temperature not properly documented Signup and view all the answers

Study Notes

Transfusion Science - Transfusion Reactions

Transfusion science focuses on the safe administration of blood products.
Transfusion reactions are adverse events resulting from blood transfusions.
Preparation for the lecture includes reviewing the NHSBT lecture and having coffee.
The aim is to discuss compatibility testing and different types of transfusion reactions.
Key learning objectives include understanding cross-matching, the range of possible reactions, and blood bank laboratory investigation methods.

Blood Grouping

Blood grouping is crucial for compatibility testing.
Nine major blood group systems exist in humans (ABO, MNS, Rh, Lutheran, Kell, Lewis, Duffy, Kidd, P).
Each system is characterized by specific antigens on red blood cell surfaces.
Blood grouping is based on the presence or absence of these antigens.

ABO Antigens and Landsteiner's Law

ABO antigens are located on chromosome 9.
Inheritance follows an autosomal dominant pattern.
Landsteiner's Law states: If an antigen is present, the corresponding antibody is absent.
The ABO system is unique; antibodies are always present.
Blood types are characterized by the presence or absence of A and/or B antigens.

Acceptance Criteria

Samples and request forms must be labeled immediately and contain the following minimum identifiers: forename, surname, date of birth, hospital number, sample date, and collection time.
The request form must be signed.
Zero tolerance policy for errors

Cross-Matching

Red cell transfusions are common for various reasons, including blood loss, surgery and anaemia.
Compatibility testing involves grouping and antibody screening.
ABO and Rh D blood groups are determined.
Patient serum is screened for the presence of clinically significant antibodies.
Electronic cross-matching uses LIMS (Laboratory Information Management System).
Matching ABO and RhD with historical records
Checking antibody screen results
Checking historical and current negative antibody screens

Immediate Spin Cross-Matching

Donor red blood cells are prepared by arranging and labelling the gel card
A 0.8% red cell suspension from donor red blood cells is produced.
50 µl of the red cell suspension is added to the card's wells.
25 µl of patient plasma is added to the wells.
Incubated at 37 °C for 15 minutes.
Centrifugation is used to detect agglutination (antibody binding).

Cross-Matching (further detail)

Compatibility between a unit of blood and the patient must be ensured.
Patient location, type, amount, date, and time specifications are needed.
Special requirements like CMV negativity or irradiation must be indicated.
Signature and name of the requestor are required
Usually takes 35-40 minutes
Unit details are printed correctly on labels and attached to the blood pack.
The unit is then placed in the issue fridge.

Indirect Coombs test

Recipient serum containing antibodies is obtained.
Donor blood is added to the serum.
The recipient’s antibodies target the donor red blood cells forming antibody-antigen complexes.
Anti-human antibodies are added to the solution.
Agglutination of red blood cells indicates a positive test

Transfusion Reactions (Types)

Acute Haemolytic Reaction
Delayed Haemolytic Transfusion Reaction
Unit contamination with bacteria
Severe Allergic Reaction
Transfusion Associated Acute Lung Injury (TRALI)
Transfusion Associated Circulatory Overload (TACO)
Post-transfusion purpura (PTP)
Non-haemolytic Febrile Transfusion Reaction (NHFTR).

Acute Transfusion Reaction

Symptoms occur within 30-60 minutes of transfusion.
The transfusion involves red blood cells that elicit an antibody response.
Rapid destruction of donor cells releases cytokines.
Common symptoms include fever, chills, pain, vomiting, tachycardia, hypotension, DIC, and shock.
The transfusion should be stopped immediately.

Delayed Transfusion Reaction

Symptoms occur 12-36 hours later (or even weeks later).
The patient's antibody against an erythrocyte antigen may have decreased to undetectable levels.
Less common, but still possible blood group antigens are targeted.
Patient's haemoglobin level will decrease. Possible symptoms include jaundice, malaise, mild fever, and/or increased antibody level and haemolysis for approximately 2 weeks following blood transfusion

Bacterial Infections

Bacterial infections in blood products can occur during collection, processing and storage.
Most frequently affect platelets.
Short expiry dates increase the risk.
Blood products may appear cloudy, have unusual colours, or show aggregates as symptoms.

Allergic Reaction

Allergic reactions can range from mild urticaria to severe anaphylaxis.
Patients with IgA deficiencies are more susceptible.
Type I hypersensitivity mechanism is common.
The risk is minimized by using red cell & platelet products from donors who lack IgA or through plasma washing (removal of plasma)

Occurs within 6 hours after transfusion.
Symptoms include sudden acute respiratory distress, hypoxia, and fever.
Donor blood antibodies react with recipient neutrophils
Damage to capillaries leads to fluid leaking into the alveolar spaces.
Diagnosis is mainly through exclusion, ruling out other causes such as acute transfusion or myocardial infarction.
Associated with approximately 10% morality

Transfusion-Associated Circulatory Overload (TACO)

A condition arising from rapid transfusion of large volumes of blood products over a short period.
A significant risk exists for patients over age 60.
Clinicians often mistake TACO for TRALI.
Patients exhibit hypertension, tachycardia, respiratory distress, and pulmonary edema.
Prevention of TACO involves careful monitoring and slower transfusion rates.

Role of the Blood Transfusion Laboratory

STOP the transfusion immediately when any reaction is suspected!
Laboratory is contacted immediately with patient details and symptoms
Transfused and unused units are sent for re-testing.
Pre-transfusion samples are re-tested.
Post-transfusion samples are tested.

Role of the Blood Transfusion Laboratory (Reporting)

Reporting of transfusion reactions, adverse events, and incorrect procedures.
SABRE (Serious Adverse Blood Reactions and Events) - MHRA reporting system.
SHOT (Serious Hazards of Transfusion) - data collection and recommendations for improved patient safety.

Case Studies

Case studies (1-3) illustrate real-world scenarios of transfusion errors and their consequences.
Errors included incorrect labeling, communication failures, and incorrect pre-administration checks during blood collection processes, resulting in transfusion reactions.

Summary

Incorrect transfusions pose a significant morbidity and fatality risk.
Zero tolerance error policies are implemented.
Human error is a significant cause of transfusion-related incidents with a year-over-year increase in errors.
Investigating transfusion incidents/near misses contributes to data collection for improving blood transfusion safety.
Adverse reactions persist as under-reported cases.

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Description

Test your knowledge on Transfusion Associated Circulatory Overload (TACO) and related adverse transfusion reactions. This quiz covers clinical signs, at-risk populations, immediate actions required during transfusion reactions, and diagnostic acronyms. Perfect for healthcare professionals and students in the medical field.