 Because of the systemic response all vessels dilate, blood pressure will decrease leading to

hypotension
 If the blood component is contaminated by gram-negative bacilli mas at risk si pasyente
 The more blood transfused, the more severe the reaction will be
 NEXTTTTTTTTT
 Endotoxins reacts to the system of the patient leading to transfusion-related sepsis
 Red blood cells are not excluded
 RBC= 4 C (bacteria that can GROW: Yersinia enterolitica, Serratia liquefaciens, Pseudomonas
fluorescens)
 TAS associated with 10% of transfusion-related death
 NEXXXXXXXXXT
 Bakit kailangan kumuha ng blood from blood bag and from the patient? To compare the
organisms that will be isolated from these two samples
 WHAT IF WALANG NAISOLATE SA BLOOD BAG BUT NAKAISOLATE SA PATIENT? Implies that
before blood transfusion may presence na ngbacteria kay recipient and non lang nagreact upon
transfusion (DI NA NATIN KASALANAN)
 NEXXXXXXXXT
 Broad-spectrum antibiotic coverage – means na wala pa specific coverage
 Acts on two major bacterial groups: gram positive and negative

Febrile

 May fever and chills, followed by increased in temp up to 30 mins. (discontinue blood trans)
 RBC is not involved; but the WBC mechanism
 HLA (human Leukocyte Antigens) and HPA (Human Platelet Antigen)
 Recipient have antibodies against the antigens present on the white blood of the donor.
 Once na natargeted ni antibodies si WBC, the damaged WBC will release pyrogens (substances
which produces fever when introduced or release into the blood)
 Another mechanism: related to platelet storage (platelet component which are not leuko-
reduced) hindi natanggalan ng WBC
 WBC upon storage will produce biologically active cytokines (has a mechanism that can cause
transfusion reaction).
 nEXTTT
 DAT negative – (will only be positive if RBC are involved)

ALLERGIC

 URTICARIAL (MILD)
 Weals (pantal) – Hive (pag madami)
 Pruritus (itchy skin)
 Recipient = IgA- deficient (may anti -IgA)
 Epinephrine – capable of improving the breathing of the patient (may pamamaga), stimulate the
heart, raise a dropping blood pressure (hypotension), reverse hives, and reduce swelling of the
face, lips and throat
 To prevent anaphylaxis or severe allergic transfusion reaction: Washing the RBC
  Mild: allergen reacting to IgE (mast cells)
 Severe: anti-IgA – IgA

Transfusion

 Acute lung injury: disorder that have acute inflammation that causes the disruption of lung
endothelial or epithelial barrier.
 Respiratory distress – occurs when fluid fills up the air spaces in the lungs
 Because of too much fluid in the lungs it can lower the amount of oxygen (hypoxemia) / increase
the carbon dioxide in the blood stream
 Immune TRALI – Antibody mediated against the HLA/HNA in the transfused blood component
reacting with recipient leukocyte causing aggregates the occlude pulmonary circulation.
 Anti-HLA/HNA = HLA/HNA = Ag-Ab complex leading to occlusion
 For TRALI to occur, these antibodies are present in the Donor; antigen are present in the
recipient
 Nonimmune TRALI – priming of patient’s neutrophils (have an increase or intensified response
leading to release of cytotoxic substances). Damage endothelium
 Neutrophils will release substances that will damage the pulmonary endothelium. Since it was
damaged, it will become permeable and fluid will leak into the pulmonary spaces. Once na
magleak sa pulmonary spaces, it will lead to respiratory distress.
 Institution for male only plasma policy/donors – consists of obtaining plasma from male donor
or nulliparous (hindi pa nabubuntis) female donor (for multiparous female donors – multiple
pregnancy)

TACO

 It occurs when the volume of transfused component causes hypervolemia (increase volume of
blood)
 Volume overload – if the patient receives multiple blood transfusion
 Distention – paglobo ng vein
 Head to the heart blood flow is increased
 Brain natriuretic peptide – a hormone that is release in response to volume expansion and
increase wall stress of cardiac myocytes
 Nasense nya yung stress ni heart, so release of hormone to promote diaresis vasodilation
 Diuresis – to get rid extra fluids

Delayed

 WIDE VARIETY/ORIGIN

DSHTR

 NOT FATAL because it only manifest new red cell antibodies

 Why would there be new antibodies? Occurs secondarily to anamnestic response or basically
the recipient receive blood containing antigens and yung kanyang system will only produce
antibodies
 No signs and symptoms
TAGVHD

 Immunocompetent cells - can produce immune response against the recipient

 Bakit kailangan nya kalabanin si WBC? HLA difference; if homozygous si donor and hetero si
recipient, si R hindi nya irerecognize as foreign si D dahil may A1 sya which is also present sa R.
 Pancytopenia – decreased of RBC, WBC and platelets
 Identify donor engraftment – definitive diagnosis for TGVHD, we need to identify donor derived
lymphocytes. Dapat makita si lymphocytes in the R circulation or tissue

POST

 Recipient received blood/pregnant – exposed to HPA

 Once exposed, the patient will produce antibodies HPA
 It also targets/destroy autologous platelets
 Because of that platelets from the donor and recipient will be destroyed leading to
thrombocytopenia
 Purpura- small blood vessels burst causing blood to pull under the skin

Iron

 Bakit may multi-organ damage? Each unit of RBC contain 250 mg of iron.
 Transfusion associated hemosiderosis
 Sickle cell anemia, hemoglobinopathies, thalassemia
 Ferritin is the primary form of iron stored inside the tissues and cells
 Iron-chelating agent – binds to the iron to the tissue
 Once bind it will be removed through urine and feces
 Neocytes – young RBCs
 Transfusion of RBCs has a theoretical benefit of reducing the iron burden
 Young – mas matagal life span nya
 Study shows that neocytes have 30-60 % longer in circulation than do rbc derived

Work-up

1. A clerical check of the compatibility tag on the blood bag, the blood bag label, and the patient
identification for discrepancies.
2. Examination of pretransfusion clotted blood specimen, an EDTA anticoagulated post-transfusion
blood specimen (perform a DAT), and the blood bag.
3. Perform a Gram’s stain on the blood in the bag and culture, if necessary, to determine the
presence of bacterial contamination.
4. Repeat the ABO/Rh typing, antibody screen, and the crossmatch to see if a patient antibody is
directed against donor cells. If antibody is suspected, an RBC panel should be performed for
identification of the antibody.
5. Examination of the posttransfusion urine.
6. Determination on posttransfusion anticoagulated specimen of PT, PTT, platelet count, fibrinogen
fibrin split products, if DIC is suggested.
7. Measurement of Hgb/Hct at frequent intervals if hemolysis is observed.