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Questions and Answers
What is a chief metabolic effect of transfusion?
What is a chief metabolic effect of transfusion?
What is a long-term complication of frequent RBC transfusion?
What is a long-term complication of frequent RBC transfusion?
What is a symptom of iron overload?
What is a symptom of iron overload?
How many red blood cell unit transfusions can cause greater morbidity than the underlying anemia?
How many red blood cell unit transfusions can cause greater morbidity than the underlying anemia?
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What is the treatment for iron overload?
What is the treatment for iron overload?
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What is transfusion-associated sepsis (TAS) caused by?
What is transfusion-associated sepsis (TAS) caused by?
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What is required for the diagnosis of transfusion-transmitted bacterial infections (TTBI)?
What is required for the diagnosis of transfusion-transmitted bacterial infections (TTBI)?
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Which blood component is especially susceptible to transfusion-transmitted bacterial infections (TTBI)?
Which blood component is especially susceptible to transfusion-transmitted bacterial infections (TTBI)?
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What is the primary reason for the absence of prior infection with the same pathogen in the recipient in transfusion-transmitted bacterial infections?
What is the primary reason for the absence of prior infection with the same pathogen in the recipient in transfusion-transmitted bacterial infections?
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Which type of bacteria is commonly associated with platelet contamination in transfusion-transmitted bacterial infections?
Which type of bacteria is commonly associated with platelet contamination in transfusion-transmitted bacterial infections?
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What is the primary mechanism of Hemolytic Disease of the Fetus and Newborn?
What is the primary mechanism of Hemolytic Disease of the Fetus and Newborn?
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What is the primary reason for the importance of RhD incompatibility in Hemolytic Disease of the Fetus and Newborn?
What is the primary reason for the importance of RhD incompatibility in Hemolytic Disease of the Fetus and Newborn?
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What is the primary method of diagnosis for maternal RBC alloimmunization?
What is the primary method of diagnosis for maternal RBC alloimmunization?
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What is the primary theory behind the formation of RBC antibodies in the mother?
What is the primary theory behind the formation of RBC antibodies in the mother?
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What is the primary purpose of hemovigilance programs?
What is the primary purpose of hemovigilance programs?
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What is the primary mechanism of transfusion-transmitted bacterial infections?
What is the primary mechanism of transfusion-transmitted bacterial infections?
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What is the indication for an exchange transfusion in a newborn?
What is the indication for an exchange transfusion in a newborn?
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What type of blood cell products are used for exchange transfusion in a newborn?
What type of blood cell products are used for exchange transfusion in a newborn?
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What is the mechanism of action of intravenous immune globulin in treating hyperbilirubinemia of the newborn?
What is the mechanism of action of intravenous immune globulin in treating hyperbilirubinemia of the newborn?
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Why is it recommended to give Rh immune globulin to RhD-negative mothers?
Why is it recommended to give Rh immune globulin to RhD-negative mothers?
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What is the recommended dose of Rh immune globulin for an RhD-negative mother?
What is the recommended dose of Rh immune globulin for an RhD-negative mother?
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What is the definition of immune hemolytic anemia?
What is the definition of immune hemolytic anemia?
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What is the purpose of phototherapy in the treatment of hyperbilirubinemia in newborns?
What is the purpose of phototherapy in the treatment of hyperbilirubinemia in newborns?
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Why is it recommended to select K-negative RBC units for women of childbearing age?
Why is it recommended to select K-negative RBC units for women of childbearing age?
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Study Notes
Transfusion-Transmitted Bacterial Infections (TTBI)
- Absence of prior infection with the same pathogen in the recipient is a risk factor for TTBI
- Clinical Presentation: • RBC contamination leads to septic reactions • Gram-negative bacteria produce endotoxins • Symptoms include fever, rigors, hypotension, nausea, and severe complications • Platelet contamination results in fever and chills, often caused by Gram-positive bacteria
- Diagnosis: • Suspect TTBI in patients with post-transfusion fever, chills, rigors, or hypotension • High suspicion level is essential as it can be confused with other reactions
- Microorganisms: • RBC contamination: Gram-negative bacteria • Platelet contamination: Gram-positive cocci • Storage conditions influence the types of bacteria involved
- Incidence: • Rates vary and are often underreported • Hemovigilance programs help improve reporting and reveal higher rates
- Prevention: • Enhanced donor screening • Improved skin disinfection • Pathogen-reduction technologies like the INTERCEPT system
Hemolytic Disease of the Fetus and Newborn
- Destruction of the RBCs of a fetus and neonate by antibodies produced by the mother
- The mother can be stimulated to form RBC Ab naturally (ABO), by previous pregnancy, or transfusion (RBC alloimmunization)
- RhD continues to remain an important cause of incompatibility, although its frequency has been equaled or surpassed by other RBC Ab specificities
- Initial diagnosis of maternal RBC alloimmunization is serologic
- Etiology: • Levine and Stetson: Postulated that mother has been immunized to the father’s antigen through fetomaternal hemorrhage
- Exchange Transfusion: • Indication: Critical levels of Bilirubin • Blood cell products: Group O, RhD-negative/RhD-positive, leukocyte reduced, HgbS negative, CMV safe, irradiated, and Ag-negative for maternal RBC Abs
- Simple Transfusion: • The infant may receive small volume or “top-off” RBC transfusions to correct anemia anytime from after birth to many weeks later
- Management:
• Phototherapy:
- Sufficient to adequately conjugate the bilirubin and lessen the need for transfusion in infants with mild to moderate hemolysis • Intravenous Immune Globulin:
- Used to treat hyperbilirubinemia of the newborn caused by HDFN
- Competes with mother’s Abs for the Fc receptors on the macrophages in the infant’s spleen, reducing the amount of hemolysis
- Prevention:
• Selection of RBCs for Females: K-negative RBC units for women of childbearing age
• Rh Immune Globulin:
- Given to RhD-negative mothers
- First dose: 28 weeks’ gestation, recommended by ACOG
- Second dose: given after delivery of an RhD-positive infant (antenetal); 18 weeks of gestation (3rd trimester)
- Recommended to give RhIG within 2 hours after delivery (Postpartum)
Autoimmune Hemolytic Anemia
- Immune hemolytic anemia - defined as shortened red blood cell (RBC) survival mediated through the immune response, specifically by humoral antibody
Adverse Metabolic Effects of Transfusion
- The chief metabolic effects of transfusion involve: • Citrate toxicity • Hyperkalemia (increased potassium)
Iron Overload
- Long term complication of frequent RBC transfusion
- Iron accumulation affects functions of heart, liver, endocrine system
- Signs and symptoms: muscle weakness, fatigue, weight loss, mild jaundice, anemia
- After 10 to 15 red cell transfusions, excess iron is present in the liver, heart, and endocrine organs
- Chronic red cell transfusion recipients have the greatest risk for developing iron overload, with a cumulative 50 to 100 red blood cell unit transfusions causing greater morbidity than the underlying anemia
- Therapy: Iron chelation agent
Transfusion-Associated Sepsis (TAS)
- Acute nonimmune transfusion reaction
- Body temperatures usually 2°C or more above normal and rigors that can be accompanied by hypotension
- Occurs when a bacteria-contaminated blood component is transfused
- Abruptness of presentation may be similar to AHTR
- Bacterial endotoxins generated during storage may contribute to TAS-related morbidity and mortality
- Diagnosis: Isolation of the same organism in both the implicated blood bag and the patient’s blood
- Treatment: Discontinue transfusion, supportive, antibiotic therapy
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Description
This quiz covers the clinical presentation, diagnosis, and symptoms of Transfusion-Transmitted Bacterial Infections (TTBI), including septic reactions and fever.
