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Adverse Effects of Transfusions Path Exam 5 (Immune (Acute Hemolytic…
Adverse Effects of Transfusions Path Exam 5
Infections
Malaria
Babesia
Prion Disease
Bacteria**
Biggest concern
Physiologic Consequences
Hypothermia
chills
V fibrillation (if :<3: chilled to fast)
Electrolyte, Acid base disturbances
Hyperkalemia
Hypomagnesemia
Hypocalcemia
**likely with massive transfusion
Clotting Consequences
Dilutional coagulopathy
Post-Op Thrombosis
Depressed Erythropoiesis
Iron Overload
Alloimmunization
Immune
Febrile Non-Hemolytic
(common w/in 6 hours of transfusion of RBCs or platelets c/b cytokines)
Fever
Chills
Dyspnea
Allergic Reactions (1-3% transfusions)
Hives
Anaphylaxis
avoid by washing RBCs
Acute Hemolytic Transfusion Reaction
ABO Incompatability :arrow_right: Complement Activation
First 15 cc of blood usually
FATAL if acute aintravascular lysis of RBCs
Labs: DAT :heavy_plus_sign:
Free Hb in serum
Hemoturia
:arrow_up:Bilirubin (delayed)
:warning:STOP TRANSFUSION IMM.
Error in Patient ID
Undetected atypical antibodies from sensitization by previous transfusion or pregnancy
Renal Tubular Damage
Cell Fragments :arrow_right: DIC
Symptoms
Burning at site of infusion
Pain in low back or Kidneys
Constitutional symptoms
Oliguria of Acute Renal Failure
Delayed Hemolytic
Same as Acute, but delayed 3-10 days after transfusion
Slow, extravascular hemolysis
Acute Lung Disease - TRALI
Most common cause serious, fatal transfusion rxn (1:10,000)
Sudden pulmonary edema :arrow_right: ARDS :arrow_right: ROS injury to pulmonary vasculature by WBCs :arrow_right: complement activation
Associated w/ FFP, Platelets, and rarely plasma in packed RBCs
Transfusion Related Immunomodulation - TRIM
Graft vs. Host Disease
(90% mortality)
Donor T cells attack recipients tissues
Rash, Diarrhea, Jaundice
AIDS, Lymphoma :arrow_up:risk
PREVENT:
Partial HLA match of donor T lymphocytes
Gamma-Irradiating blood (parent insists on giving blood to child)