Febrile non hemolytic transfusion reaction

TACO

Bacterial contamination

Post transfusion purpura

Disease transmission

TA-hemosiderosis

DHTR

TA-GVHD

TRALI

Allergic/ Anaphylactic

IHTR

Febrile non hemolytic transfusion reaction

Allergic/ Anaphylactic

TRALI

TACO

Bacterial contamination

Post transfusion purpura

DHTR

TA-GVHD

TA-hemosiderosis

Disease transmission

Cause: Incompatible blood transfused (commonly ABO)

A patient develops fever, chills, flushing, nausea, dyspnea, chest pain, flank pain, pain at the infusion site, hypotension, shock, hemoglobinemia, hemoglobinuria, DIC, and renal failure. Which reaction is most likely?

Prevention involves avoiding clerical error and using trained staff

A rise in temperature of ≥1°C with chills rigor, tachycardia, nausea or vomiting, increase BP and tachypnea during transfusion most likely indicates:

Prevention and Treatment: 1. Transfuse of leukocyte reduced products to patients who have experienced two or more FNHTR 2. Administer antipyretics to resolve fever 3. Meperidine – to resolve rigor but it must be caused with extreme caution

A patient develops hives and wheals, etching, erythema, and pruritus. What condition is likely?

can range from minor urticarial effects to fulminant anaphylactic shock and death

Prevention and Treatment: 1. Use washed RBC, administer anti-histamine

A patient with IgA deficiency (<0.05 mg/dL) develops bronchoconstriction, angioedema, and hypotension after a few milliliters of blood. What reaction is this?

Sign and Symptoms: Bronchoconstriction (wheezes), angioedema (periorbital edema, tongue swelling), gastrointestinal symptoms (diarrhea), and cardiovascular instability (hypotension, cardiac arrhythmia, loss of consciousness, shock, cardiac arrest).

Prevention and Treatment: 1.Transfuse washed RBCs or platelets or frozen RBCs and plasma from IgA deficient donors 2. Give epinephrine (usually about 0.5 mL of 1:1000 solution) immediately 3. For severe reactions, corticosteroids or aminophylline, or both, may be indicated

First-line treatment for anaphylaxis during transfusion is:

Treatment for TACO includes:

Which feature distinguishes anaphylaxis and anaphylactoid from other transfusion reactions?

Best prevention for recurrent FNHTR is:

The most common cause of an acute hemolytic transfusion reaction is:

Cause: Preformed antibody antibodies and causes the release of endogenous pyrogens

Cause: ALTR occurs as a response of recipient antibodies to an allergen present in the blood component Due to donor plasma proteins (allergens)

Cause: Attributed to IgA deficiency or absolute IgA deficiency (IgA levels less than 0.05 mg/dL) in patients who have developed anti IgA antibodies by sensitization from transfusion or pregnancy

Cause: Anti-leukocyte antibodies, Anti-HLA, and Anti-neutrophil antigen that are present in plasma of the transfused unit

It is now recognized that there are non-antibody-mediated cases caused by certain mediators that activate endothelial cells in pulmonary microcirculation

A patient develops fever, chills, dyspnea, cyanosis, and bilateral pulmonary edema on chest x-ray within 6 hours of transfusion. What condition is this?

consists of an acute transfusion reaction presenting with respiratory distress and severe hypoxemia during or within 6 hours of transfusion in the absence of other causes of acute lung injury (e.g., aspiration, pneumonia, toxic inhalation, lung contusion, near drowning, severe sepsis, shock, multiple traumas, burn injury, acute pancreatitis, cardiopulmonary bypass, drug overdose)

Prevention and Treatment: Use of proper donor selection and Use of leukopoor RBCs unit

A patient with heart disease develops dyspnea, orthopnea, hypertension, JVD, and pulmonary edema during transfusion. What reaction is this?

Signs and Symptoms: It presents as congestive heart failure during or shortly after transfusion. Signs and symptoms can include dyspnea, orthopnea, cyanosis, tachycardia, elevated blood pressure, pulmonary edema, jugular venous distention, pedal edema, and headache

second most common cause of transfusion related deaths reported to the FDA, and the incidence appears to be increasing

Which is a major risk group for TACO?

A key preventive measure for TRALI is the use of:

TRALI is primarily caused by donor plasma containing:

Cause: Iatrogenic (physician-induced)

Cause: Pathophysiology is unknown

Transfusion-Associated Dyspnea is often seen in allergic reactions as well as?

Cause: Initial case reports implicated bedside leukoreduction filters and/or angiotensin-converting enzyme inhibitors

Nonspecific sign, diagnosed when hypotension is seen alone or during 1 hour after the transfusion, a drop in the systolic BP of ≥30 mmHg and systolic BP of ≤80 mmHg

Cause: Caused by psychrophilic bacteria

occurs when bacteria are introduced to the patient via a contaminated blood product, manifested by an increase in body temperature or more than 2°C, rigors, and hypotension

Signs and Symptoms: Fever, rigor, chills, hypotension, tachycardia, shock, DIC, hemoglobinuria, hemoglobinuria, renal failure

Prevention and Treatment: 1. Administer IV antibiotics 2. Carefully inspect blood products before distribution for transfusion 3. Proper sterilization technique 4. Visual inspection of units (check for clots, and changes of color of plasma, or hemolysis) 5. Phlebotomy diversion consists of collecting the first 20 to 30 mL of blood in a separate container to be used for testing. This reduces the quantity of skin contaminants entering the unit during phlebotomy and appears to be very effective in reducing Staphylococcus species contamination

According to CDC, it is the Most common cause of death by bacterial contaminated blood components

Most common isolate found in RBC units

Second most common isolate found of RBC units

Common isolate of human skin, was the most common bacterial contaminants in RBC

Most frequently recovered from donated blood and contamination of platelet

Most common bacterial contaminants of blood

Accounts for the greatest number of deaths due to blood product contamination reported to the FDA from FY2011 to 2015, all of which were platelet products

Cause: Incompatible blood transfusion especially Kidd blood group (most common)

Cause: Delayed immune transfusion reaction due to an immunologic attack by viable donor lymphocytes (T cells) contained in the transfused blood component against the transfusion recipient Recipient who are immunocompromised or with immunodeficiencies, with cancer, or infants are at risk

Cause: Anti-platelet antibodies (Anti-human platelet-1a/Anti-HPA-1a, anti human platelet-3a/Anti-HPA-3a)

Cause: Iron overload is a delayed, nonimmune complication of transfusion, presenting with multiorgan (i.e., liver, heart, endocrine organs) damage secondary to excessive iron accumulation

A patient develops fever, mild jaundice, pallor, and decreased haptoglobin one week after transfusion. What reaction is most likely?

Prevention and Treatment: 1.Check patient’s previous records 2. Make notation on patient’s antibody status in permanent laboratory protocol 3. Administer antigen negative blood for all subsequent transfusion

Signs and Symptoms: Fever, maculopapular skin rash, scleroderma-like, sicca syndrome, interstitial pneumonitis, pancytopenia, abnormal liver function (elevated liver function test such as enzymes), diarrhea with bloody stool

Prevention and Treatment: 1. Usage of irradiated blood products. AABB Standards requires a minimum dose of 25 Gy (2,500 cGy) delivered to the central portion of the container and a minimum of 15 Gy (1,500 cGy) dose elsewhere in the container to the products given to at-risk patient populations 2. Usage of immunosuppressive medications 3. Hematopoietic stem cell transplantation

s a rare transfusion reaction in which there is a severe and sudden drop in the platelet count, usually occurring 5 to 10 days after transfusion due to alloimmunization to platelet-specific antibodies from prior transfusion or pregnancy

Signs and Symptoms: Profound self-liming thrombocytopenia, generalized purpura, bleeding

self-limiting syndrome with the platelet count usually returning to normal within 2 weeks

Signs and Symptoms: Muscle weakness, weight loss, mild jaundice, fatigue, cardiac arrhythmias, mild diabetes, and multi-organ failure

Prevention and Treatment: 1. Administration of Iron chelating agent such as deferoxamine or desferrioxamine 2. Transfusion of neocytes (young RBCs)

The most common blood group system associated with delayed hemolytic transfusion reactions is: