Non-h emol yt ic Tr ansf usio n Reactio n

Group members: (2006838514) (2005604631) (2006838393) (2006838665)

Febrile Reactions
Etiology
•Most commonly reported transfusion rxns •Most common type – due to cytotoxic antibodies / leukoagglutinins (leukocyte antibodies) •If these antibodies present in the recipient's plasma, a rxn occur btwn the ab & the ag of transfused leukocytes /

Signs & Symptoms
•Fever, often accompanied by chills whichbegins during / soon aft transfusion •Fever associated wif a febrile non – hemolytic rxn defined as a rise in body temp of 1oC / >, occurring in association wif da transfusion of blood / components

Prevention
•Documenting da existence of leukoagglutinins •Tests such as leukoagglutinins & microlymphototoxicity assays •Leukocyte – poor preparations is recommended (only after a patient has had 2 / > febrile non – hemolytic rxns

Circulating Overload
Etiology
•Can result from rapid transfusion of large volumes of blood w/o equivalent blood loss •Can also occur aft transfusion of small amounts of blood to patients wif abnormal cardiac f(x) & reserve

Signs & Symptoms
• Typical symptoms: 4.Severe headache 5.Dyspnea 6.Cyanosis 7.Congestive heart failure - Pulmonary edema develop

Prevention
•Use of packed erythrocytes •Administered slowly – for patients dat r x actively bleeding / susceptible to circulatory overload •Preferable to hv patient in a sitting position •Prefer to divide full units of packed red cells in half – 1 divided unit trannsfused while da other remains refrigerated (some clinicians)

•Da attending physician may also order da administration of a diuretic medication to reduce fluid retention •In patients wif low hematocrits (1520%),phlebotomy of whole blood followed by da transfusion of packed red cells may be useful in increasing O2 – carrying capacity w/o expanding blood volume

Bacterial contamination

Introduction
Rare but life threatening and very serious acute transfusion reaction (rxn).  Non-immunologic transfusion rxn  doesn’t involve Ag-Ab rxn.  Bacteria may multiply during storage  Gram positive and Gram negative organisms have been implicated.

Causes/Sources
Donor’s skin  Donor’s bacteremia  Contaminated equipments during blood collection/processing .

Bacterial growth in platelets

Platelet storage T is ideal for proliferation of many types of bacteria ( 20-24°C). Platelets are the components in which bacterial contamination is most often detected. Large proportion of platelets are administered to patients who are immunosuppressed - ↑ risk of infection.

Bacterial growth in RBCs

 

Some organisms grow well in cold storage - transfusion of red cells containing such psychrophilic Gramnegative bacteria  no complications to fatalities. E.g. Yersinia enterocolitica, E.coli Almost always associated with donors having asymptomatic bacteraemia.

Symptoms
Very high fevers (hyperpyrexia)  Rigors  Profound hypotension  Nausea  Diarrhoea  Dyspnoea  Vomiting *minutes after starting transfusion/ delayed several hours

Management
Immediately stop the transfusion and notify the hospital blood bank.  After initial supportive care, blood cultures should be taken (fm pt) and broad-spectrum antimicrobials commenced.  Laboratory investigation will include culture and Gram staining of the implicated component.

Anaphylactic type

Introduction
One of the most severe & rare rxns.  Can occur after as little as a few mLs of transfused bld.  Rxns are very severe and can be life threatening if no prompt actions taken.

Causes
Patients with IgA deficiency  anti Ig-A Ab.  Ig A  found in most people, also in plasma that accompanies donated RBCs, platelets, FFP, & cryo.

Symptoms
Anaphylactic and anaphylactoid reactions have signs of cardiovascular instability including: Hypotension  Tachycardia  Loss of consciousness  Cardiac arrythmia  Shock  Cardiac arrest * sometimes respiratory involvement with dyspnoea and stridor are prominent

Unlike Non-hemolytic febrile transfusion rxn & hemolytic transfusion rxn, this transfusion rxn x demonstrate with a fever.  Other common signs are :

skin flushing  Vomiting  Diarrhea

Management
Immediately stop transfusion.  supportive care including airway management may be required.  Adrenaline/epinephrine may be indicated  hypotension.  Ig levels and anti-IgA Abs should be investigated  Pt  given IgA deficient plasma (sp ordering).

Allergic reaction: • Common transfusion reaction, can be mild, moderate, or life-threatening • One may experience these… Urticaria, pruritis, rash, flushing Dyspnea Anxiety Wheezing Hypotension Nausea • Indistinguishable on examination from most food or drug allergies

pruriti s

urticaria

•Those clinical presentation suggest - expose to foreign substances in the blood product to which the recipient is sensitized. •IgE-mediated Transfused soluble Ag – react with IgE molecule – degranulation – allergic mediators…..

IgE bound to mast cells was preformed in response to exposure to an antigen. Mast cells contain histamine and circulate with bound IgE.

Y Y

Y Y
Y Y

IgE

YY YY
Histamine

Y

Y

Y

Y

Y

Y

Y

A

B

C

Antigens from plasma Antigen binding causes activation of histamine bind to pre-formed IgE attached to mast cellsrelease mechanism from mast cells.

Histamine is released from mast cells and causes increase in vascular permeability

Y

Y

Y
Y

Y
Y

Y

Y

Y

Y

Y

WHAT TO DO? •Stop transfusion •Keep venous access open •Treat symptoms – antihistamines are administered orally or intramuscularly •Do a treatment reaction workup – patient with recurrent urticarial reaction – pretreated with antihistamines prior to transfusion

Red cell may damage as results from •Improper storage – overheating or freezing •Way of preparation – freezing without a cryoprotective agent •Mechanical stress - cardiopulmonary bypass pumps or from roller pumps in the blood pump •simultaneous administration or mixing of drug •Hypotonic(5% dextrose in water) or hypertonic(50% dextrose in water) solutions Causes hemolysis….

In this situation, the blood is hemolyzed before it is transfused to the patient. Patient do not show serious complication, commonly asymptomatic hemoglobinuria. They might accompany an immune hemolytic transfusion reaction or the infusion of bacterially contaminated blood.

WHAT TO DO? Document the cause – if patient has experienced any hemolytic reaction Fluid therapy and monitored for further sign and symptoms – if the transfusion initiate disseminated intravascular coagulation (DIC) Prevention – adherence to the standards established preparation, storage and infusion of blood….

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