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Blood transfusion reactions and complications

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Blood transfusion reactions and complications

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Blood transfusion reactions and complications

  1. 1. TRANSFUSION REACTIONS AND COMPLICATIONS 09/10/2014 CME Teaching Emma McVeigh
  2. 2. 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 38.7oc Oxygen Sat 90% R.A. RR28 HR104 BP101/68
  3. 3. INVESTIGATIONS CXR:
  4. 4. MANAGEMENT ???
  5. 5. BLOOD TRANSFUSION IN ED
  6. 6. BLOOD TRANSFUSION REACTIONS Febrile non-haemolytic transfusion reaction Bacterial Infection reaction Allergic/ Urticarial transfusion reaction Anaphylactic/ Immunologic transfusion reaction Transfusion Associated Acute Lung Injury (TRALI) Transfusion Associated Circulatory Overload (TACO) Iron Overload Acute Haemolytic Reaction Delayed Haemolytic Reaction Transfusion Associated Graft – VS – Host Disease
  7. 7. FEBRILE NON-HAEMOLYTIC REACTION
  8. 8. BACTERIAL TRANSFUSION REACTION
  9. 9. ALLERGIC / URTICARIAL REACTION
  10. 10. ANAPHYLACTIC REACTION
  11. 11. T.R.A.L.I.
  12. 12. CANADIAN CONSENSUS CRITERIA FOR TRANSFUSION-RELATED ATRACLI: UTE LUNG INJURY 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.
  13. 13. T.A.C.O.
  14. 14. IRON OVERLOAD
  15. 15. ACUTE HAEMOLYTIC REACTION Clinical 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
  16. 16. DELAYED HAEMOLYTIC REACTION
  17. 17. TRANSFUSION ASSOCIATED GRAFT-VS-HOST DISEASE (GVHD)
  18. 18. MANAGEMENT OF TRANSFUSION REACTION 1. 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
  19. 19. 2014 Australian Red Cross Blood Service
  20. 20. SCGH GUIDELINES http://chips/departments/transfusionservices/pdf/PolicyManu al/Transfusion%20Reaction%20Algorithm.pdf http://chips/departments/transfusionservices/pdf/PolicyManu al/Transfusion%20Reaction%20Algorithm.pdf
  21. 21. 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
  22. 22. RISK FACTORS 1. Individual patient characteritics 2. Blood Component 3. Equi[ment 4. Concomitant Medications 5. Procedures
  23. 23. PREVENTION
  24. 24. 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
  25. 25. 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
  26. 26. PATIENTS FOR WHOM LEUKOREDUCED BLOOD PRODUCTS SHOULD BE CONSIDERED 1. 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
  27. 27. CASE REPORT 68yo lady b/g CML px ED with Respiratory Distress and febrile ?Diagnosis ?Management Plan
  28. 28. SUMMARY… 1. Risk Factors for Transfusion Reaction 2. Early Identification 3. Early Notification 4. Supportive Management 5. Prevention Transfusion Reaction
  29. 29. 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
  30. 30. THANK YOU! ??????QUESTIONS??? ??

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