blood transfusion reactions and complications
DESCRIPTION
Blood transfusion reactions and complicationsTRANSCRIPT
TRANSFUSION REACTIONS AND COMPLICATIONS
09/10/2014 CME TeachingEmma McVeigh
CASE REPORT
68 year old lady background of CML referred to Emergency Department from the Transfusion Day Ward. She was receiving 2nd unit RBC when became febrile and increasingly dyspnoeic.
O/E:
Pyrexic 38.7ocOxygen Sat 90% R.A. RR28HR104BP101/68
INVESTIGATIONS
CXR:
MANAGEMENT
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BLOOD TRANSFUSION IN ED
BLOOD TRANSFUSION REACTIONSFebrile non-haemolytic transfusion reactionBacterial Infection reactionAllergic/ Urticarial transfusion reactionAnaphylactic/ Immunologic transfusion reactionTransfusion Associated Acute Lung Injury (TRALI)Transfusion Associated Circulatory Overload (TACO)Iron OverloadAcute Haemolytic ReactionDelayed Haemolytic ReactionTransfusion Associated Graft – VS – Host Disease
FEBRILE NON-HAEMOLYTIC REACTION
BACTERIAL TRANSFUSION REACTION
ALLERGIC / URTICARIAL REACTION
ANAPHYLACTIC REACTION
T.R.A.L.I.
CANADIAN CONSENSUS CRITERIA FOR TRANSFUSION-RELATED ACUTE LUNG INJURY TRALI:
1. Acute onset during or within 6 hours of transfusion
2. Hypoxemia
3. Bilateral infiltrates on chest x-ray
4. No evidence of volume overload
5. No preexisting lung injury
6. No alternative risk factor for ALI
Possible TRALI:
1. Criteria for TRALI, as stated above in criteria 1-5
2. Alternative risk factor for ALI identified (ie, sepsis)
Abbreviations: ALI, acute lung injury; TRALI, transfusion-related acute lung injury.
T.A.C.O.
IRON OVERLOAD
ACUTE HAEMOLYTIC REACTIONClinical Features Pathophysiology
Emergency!! ABO incompatible blood, eg group A, B or AB red cells to a group O patient
Haemolysis Human error
Fever
Back pain
Haemoglobinuria
ARF
DIC
Note: Difficult to assess patients – intubated/ ICU setting
DELAYED HAEMOLYTIC REACTION
TRANSFUSION ASSOCIATED GRAFT-VS-HOST DISEASE (GVHD)
MANAGEMENT OF TRANSFUSION REACTION1. Stop the transfusion immediately
2. Check and monitor vital signs
3. Maintain intravenous (IV) access (Do not flush existing line and use a new IV line if required)
4. Check the right pack has been given to the right patient
5. Notify Lab
2014 Australian Red Cross Blood Service
SCGH GUIDELINES
http://chips/departments/transfusionservices/pdf/PolicyManual/Transfusion%20Reaction%20Algorithm.pdf
http://chips/departments/transfusionservices/pdf/PolicyManual/Transfusion%20Reaction%20Algorithm.pdf
INVESTIGATIONS Immediate post transfusion blood samples (clotted and EDTA)
Repeat ABO & Rh (D) grouping G+XM Direct antiglobulin test FBC Haptoglobin Coagulation screen RFT LFTSs (BR) DIC (DD/Fibrinogen)
Blood culture in special blood culture bottles
Blood unit
Specimen of patient’s first urine following reaction u/a - bilirubin
RISK FACTORS
1. Individual patient characteritics
2. Blood Component
3. Equi[ment
4. Concomitant Medications
5. Procedures
PREVENTION
PREVENTION
1. Correct identification patient and blood products
2. Following protocol
3. ?use of prophylactic drugs
4. Identification of risk groups
5. Treatment of blood products
PATIENTS FOR WHOM GAMMA IRRADIATED BLOOD PRODUCTS SHOULD BE CONSIDERED 1. Patients with known or suspected congenital
immunodeficiency syndromes
2. Patients with hematologic malignancies (leukemia, lymphoma)
3. Patients with solid tumors receiving chemotherapy
4. Patients after bone marrow transplant
5. Patients receiving human leukocyte antigen-matched donations or directed blood prodcuts from first-degree relatives
PATIENTS FOR WHOM LEUKOREDUCED BLOOD PRODUCTS SHOULD BE CONSIDERED1. Patients who are non-hepatic solid organ transplant candidates
2. Patients who have had 1 or more documented FNHTR
3. Patients requiring long-term platelet support (eg, aplastic anemia, ITP)
4. Patients at risk for clinically significant CMV infection (eg, bone marrow transplant recipients, etc.)
5. Abbreviations: CMV, cytomegalovirus; FNHTR, febrile nonhemolytic reaction; ITP, idiopathic thrombocytopenic purpura
CASE REPORT
68yo lady b/g CML px ED with Respiratory Distress and febrile
?Diagnosis
?Management Plan
SUMMARY…
1. Risk Factors for Transfusion Reaction
2. Early Identification
3. Early Notification
4. Supportive Management
5. Prevention Transfusion Reaction
REFERENCES
1. Toy P, Popovsky MA, Abraham E, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33(4):721-726. (Review)
2. Kleinman S, Caulfield T, Chan P, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion. 2004;44(12):1774-1789.
3. 2014 Australian Red Cross Blood Service. http://www.transfusion.com.au/adverse_events/management_steps
4. Rosa Sanchez, MD, Peter Bacchetti, PhD, Pearl Toy, MDTransfusion-Related Acute Lung Injury: A Case-Control Pilot Study of Risk Factors American Journal of Clinical Pathology. Am J Clin Pathol. 2007;128(4):128-134. v
5. Reprinted from Transfusion Medicine Reviews, Vol 6/ issue 2, Jeanne V. Linden, Patricia T. Pisciotta. Transfusion-associated graft-versushost disease and blood irradiation, pages 116-123. Copyright 1992. Elevesier.
6. Ratko TA, Cummings JP, Oberman HA, et al.Evidencebased recommendations for the use of WBC-reduced cellular blood components. Transfusion. 2001;41(10):1310-1319
7. Cadogan m. http://www.lifeinthefastlane.com/education/symptoms/transfusion-reaction/ Dec 2011
THANK YOU! ??????
QUESTIONS?????