Chapter 36 Transfusion Reactions.pptx

Chapter 36 Transfusion Reactions Johnmerson C. Yap, MD Clinical Pathology Department of Pathology Febrile Nonhemolytic Reaction - Rise in temperature of ≥1⁰C beyond normal accompanied by chills or rigors - Due to accumulation of pyrogenic cytokines - Must rule out HTR or bacterial contamination o...

Chapter 36 Transfusion Reactions Johnmerson C. Yap, MD Clinical Pathology Department of Pathology Febrile Nonhemolytic Reaction - Rise in temperature of ≥1⁰C beyond normal accompanied by chills or rigors - Due to accumulation of pyrogenic cytokines - Must rule out HTR or bacterial contamination of unit - Rx: Not required since FNHTR is usually self-limited (resolves in 2-3 hrs.) - To Decrease Risk: o Filtration o Plasma removal o Washing of cellular blood components o Transfuse Platelets intravascular hemolysis - Much less severe than AHTRs except when anti-Rh, anti-Kell, or anti-Kidd Abs are involved - Labs: Anemia, ↑LD, hyperbilirubinemia, ↓haptoglobin, ↑WBC, (+) new RBC Ab, (+) DAT Treatment:  Symptomatic treatment  Exchange transfusion for large burden Ag-positive RBCs  High-dose IVIG  Transfusion-Related Acute Lung Injury (TRALI) - Symptoms present during or soon after transfusion of any plasma-containing blood product and have no sign of cardiac failure Causes: o Presence of Abs in the plasma of transfused unit directed against HLA (MHC class I) or granulocyte Ags o Presence of lipid inflammatory mediators that activate already primed recipient neutrophils - Dyspnea, hypoxemia, tachycardia, cyanosis, fever & hypotension - Lack of abnormal breath sounds CXR: Noncardiogenic pulmonary edema (generalized pattern)* - Symptoms resolve within 48-96 hours (2-4 days), but CXR findings may persist >7 days; no permanent pulmonary sequelae Differential Diagnosis: TACO, bacterial contamination, allergic reaction, ARDS, PE, pulmonary hemorrhage  Transfusion-Associated Circulatory Overload (TACO) - Presents as CHF during or shortly after transfusion - CXR: Pulmonary edema along the major vasculature (↑PWP) - DDx: TRALI, allergic reactions, valvular disease & other causes of CHF not related to transfusion - ↑ Risk: Preexisting heart disease o Transfuse slowly or transfuse small aliquots o Plasma removal o Administration of diuretic before or after transfusion Transfusion-Associated Graft-Versus- Host-Disease (TA-GVHD) - Occur when viable donor T cells proliferate & are not recognized by the recipient’s immune system as foreign, but donor T cells recognize & reject the host as foreign - ↑Risk: Recipients with marked cellular immunodeficiency - Humoral immunodeficiencies (i.e., CVID) are not at risk - Manifest 2-50 days after transfusion - Rash, diarrhea, fever, liver dysfunction, pancytopenia - Prevention: Irradiation of units - Transfusions from biologic relatives (1st or 2nd degree relatives)  TA-GVHD: Indications for Irradiation of Blood Components Absolute Indications  Congenital cellular immunodeficiencies o DiGeorge syndrome o Severe combined immunodeficiency (SCID) syndrome  Immaturity of the immune system o Intrauterine transfusions (IUTs) o Transfusion to neonates who have received IUT o VLBW infants  Disease-associated immunodeficiencies: Hodgkin lymphoma (HL)  Therapy-associated cellular immunodeficiencies o Hematopoietic progenitor cell transplantation o Granulocyte transfusions o Chemotherapy with purine analogs (fludarabine)  Transfusions from biologic relatives (1st or 2nd degree relatives)  TA-GVHD: Indications for Irradiation of Blood Components Probable Indications  LBW infants (