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Transfusion reaction :cherry_blossom: (:cocktail:1. Hemolytic transfusion…
Transfusion reaction :cherry_blossom:
Transfusion reaction :red_flag:
(complication fr blood transfusion)
Classification based on
Timing
:grapes:
:fish:
Acute
:balloon:
happens
within 24 hrs
Immune
:stars:
Acute hemolytic transfusion reaction
:stars:
Allergic reaction
:stars:
Febrile non-hemolytic transfusion reaction (FNHTR)
TRALI
Anaphylactic
Non-immune
Circulatory Volume overload
Transfusion associated sepsis
Bacterial contamination
Non-immune HTR
:fish:
Delayed
happens
after 24 hrs
Immune
DHTR
TA-GVHD
PTP
Alloimmunization
Non-immune
Iron overload
Immunomodulation
TTD
:balloon:
Acute complication
:level_slider:
Levels
:small_red_triangle: Moderate reaction: FNHTR
:small_red_triangle:Severe reaction: Anaphylaxis, Intravascular hemolysis, Sepsis, Infection
:small_red_triangle: Mild reaction: Allergic reaction
:dango:
Ddx for Fever
Febrile non-hemolytic transfusion reaction (FNHTR)
Acute hemolytic transfusion reaction
Transfusion associated sepsis
:rice_ball:
Ddx for Hypotension
Acute hemolytic transfusion reaction
Transfusion associated sepsis
Anaphylaxis
:cocktail:
1. Hemolytic transfusion reaction (HTR)
Hypersensitivity
II
:two: reaction
(fr pt got Ab against receiving Ag
esp. ABO, Rh blood group
➯ Ag-Ab complex — Hypersen Type II ➯ induce complement via classical pathway ➯ ปลายทางมี MAC complex ➯ ปลายทาง hemolysis ➯
Intravascular
— first clinical is
coke-colored urine
:stars:
PathoPSO involves 4 systems
:grapes:
Complement activation
Cytokines ➯ Fever & vasodilation
Coagulation pathways ➯ DIC
Shock & Renal failure
Symptoms of acute hemolytic reaction
:grapes:
:leaves:
S&S
Happens
acutely — min after receiving blood
Self conscious?
Unconscious initially: notice Blood pressure, Urine color
Conscious: Fever, Chills, Tea colored urine, ปสว.สีเข้มขึ้น, Palpitation, Hypotension, DIC
:male-scientist::skin-tone-3:
Lab
CBC
BUN/Cr
Electrolyte
*Direct
Coomb’s test
PT, PTT
Hemoculture
:green_apple:
Mx
:no_entry: stop blood transfusion
Report to Blood bank (:star: also sending
blood & blood component infusion set back to blood bank
to test again)
Gives O2 & IV fluid (NSS)
Diuretic IV
If found DIC ➯ correct coagulopathy
:cocktail:
2. Febrile non-hemolytic transfusion reaction (FNHTR)
:gear:
PathoPSO
:arrow_up: cytokines amount ขณะเก็บรักษาโรค
(cytokines produce fr wbc: IL1, IL6, TNF)
Ab of Recipient
binds to
Ag on surface of WBC or Plt of donor
:leaves:
S&S
Fever, chills, flushing face, palpitation
after blood transfusion
:lollipop:
must Ddx with
Bacterial contamination & Hemolysis
:green_apple:
Mx
:no_entry: stops blood transfusion
IV fluid
Paracetamol (if ไข้ลดลง ➯ may able to continue blood)
anti-histamine IV
Record I/O
Return blood & infusion set back to blood bank
:green_heart:
Prevention
Premed of paracetamol oral
Gives blood more slowly
:cocktail:
3. Allergic reaction
:gear:
PathoPSO
Allergy to
Protein
in plasma
:leaves:
S&S
: urticaria and red rash after giving blood
:green_apple:
Mx
:no_entry: stops blood
Evaluate Airway (ฟังปอด), Gives O2 if เหนื่อย
Anti-histamine CPM 0.1mg/kg/dose IV
Then evaluate symptoms ดีขึ้นมะ?
Better ➯ Continue blood transfusion
Not better ➯ may consider steroid or epinephrine
:lollipop: must
Ddx with Anaphylaxis
— got rash, GI involvement, Respi involvement, V/S changes
:green_heart:
Prevention
Case ไม่เคยแพ้รุนแรง ➯ Gives Antihistamine prior to giving blood every time
Case แพ้รุนแรง ➯ premed with Steroid & ให้ wash RBC
:cocktail:
4. Transfusion Related Acute Lung Injury (TRALI)
:gear:
PathoPSO
:star: HLA Ab of donor
reacts with
HLA Ag on the Recipient’s surface of RBC ➯ stimulate PMN at pulmonary vss to secrete oxidase and protease ➯ :arrow_up: capillary permeability of pulmonary vss
:leaves:
S&S
Fever, cough, หายใจหอบเหนื่อย
after receiving blood < 6 hr
Usu happens 2-4 hrs after receiving blood
:lollipop:
must Ddx with Volume overload (TACO), CHF
:green_apple:
Mx
:no_entry: stop blood transfusion
Supportive Rx
Restrict volume
:cocktail:
5. Transfusion associated sepsis
:gear:
PathoPSO
Bacteria contamination in process of donor and prep blood
:leaves:
S&S
High Fever, Chills
Hypotension, Renal failure, DIC
:green_apple:
Mx
:no_entry: stops blood transfusion
Starts ATBs
:open_mouth:
Suspected of transfusion reactiom
:no_entry: stops blood transfusion
Check ฉลากทุกส่วน— blood bag, ใบขอเลือด, ใบส่งเลือด, pt info
Gives IV & Measure BP
Report doctor, blood bank and initial Rx
Send sample of blood and infusion set (that did transfuse blood) to blood bank for further test