best ppt on transfusion reaction

1. CHPTER -TEN
Transfusion Reaction
CH

2. Content
 Types of transfusion reaction
 Laboratory tests to be done when transfusion
reaction occurs

3. Learning Objectives
At the end of this chapter, the student will be able to:
 Define the transfusion reaction and transfusion
transmitted diseases
 Classify the transfusion reactions
 Carryout laboratory tests to detect causes of
transfusion reactions
 Investigate the causes of transfusion reactions
 List transfusion transmitted diseases

4. 10.1 Transfusion reactions
 Also called adverse reactions to transfusions
 Are any unfavorable responses by a patient
following transfusion of blood, blood components or
derivatives.
Example:
 Facial flushing
 Chest / back pain,
 Chills,
 Fever ,
 Cyanosis, Dyspnea,

5. 10.1.1. Types of Transfusion Reaction
Transfusion reaction is divided into:
A .Hemolytic reactions-
-abnormal destruction of RBCs of either the donor or
recipient
B. Non hemolytic reactions-
-not usually associated with RBC hemolysis
a. Febrile reactions (pyogenic reactions)
b. Allergic reactions
c. Bacteriogenic reactions
d .Circulatory overload

6. Types of Transfusion…..
Characteristics of non hemolytic reactions:
 Shortened post transfusion survival of RBCs
 Febrile reactions,
 Allergic response and
 Disease transmission.

7. Types of Transfusion…..
Cause haemolytic transfusion reactions (HTR)
 Incompatible blood,
 Blood under great pressure
 Transfusion of hemolyzed ,overheated or
frozen blood,
HTR can be:
 immediate or delayed.

8. Types of Transfusion…..
1. Immediate Type
 hemolysis evidence is obtained during or
immediately after blood is infused due to
destruction of donor cells by the recipient’s Abs.
 Two types:
a. intravascular
b. extravascular

9. Types of Transfusion…..
a. Intravascular-
It is due to:
 ABO incompatibilities due to clerical errors (Usually)
 Antibodies to other blood group antigen systems
may also be involved in immediate HTR (Rarely)

10. Types of transfusion…..
b. Extravascular-
It is due to:
-Coating of red cell antigen by incompatible Abs which
results in the removal of the red cells in liver & spleen.
-Any IgG, non agglutinating, non-complement binding
form of antibody

11. Types of Transfusion…..
Causes of immediate hemolytic transfusion rxns
 Failure to recognize antibodies present recipient
serum/plasma prior to transfusion
 Failure to recognize donor antibodies before
transfusion
 Administration of blood considered compatible on
the basis of an incompatible cross match
 Erroneous identification of recipient, donor or both
etc...

12. Types of transfusion…..
2. Delayed HTR
 Are not so dramatic and are usually noticed a
week or two after a transfusion.
 Abs to Ags other than ABO,( Rh, Kell, Duffy,
Kidd) Ag systems are commonly responsible.
 occur because of an anamnestic response
(previously encountered Ags)
-transfusions or
-pregnancies.

13. Types of Transfusion…..
 The Abs screen on the patient's serum and the
major cross-match may well have been normal
during the initial testing.
 They are subtle in their manifestations and present
 only as a mild jaundice or
 as a failure of the Hb to rise as expected.
 Are not preventable ,because Abs are :
- not present or
-below the detectable level

14. Types of Transfusion…..
2.Non-Hemolytic transfusion reactions
a. Febrile reactions (pyogenic reactions)
 The patient develops fever and chills during or after
transfusion
 The rise in body temperature may be due to leukocyte
Abs ,platelet Abs or Pyrogens
 Prevented by giving leukocyte and platelet poor RBCs

15. b. Allergic reactions
 Most common type is urticaria (an itchy rash)
 Characterized by flushing of the skin & dyspenia.
 Commonly caused by the interaction between
transfused IgA and class specific anti-IgA in the
recipients plasma.
 controlled by giving anti-histamines
Types of Transfusion…..

16. Types of Transfusion…..
C. Bacteriogenic reactions
 Caused by bacteria that may contaminate solutions
or equipments before sterilization
 Transfusion of bacterially contaminated blood
components
 Common problem for platelet concentrates stored at
room temperature

17. Types of Transfusion…..
Signs of bacteriogenic reactions
 Rapid onset of chills & fever
 Vomiting
 Diarrhea
 Profound hypotension
 Shock

18. Types of transfusion…..
To minimize the risk of infection of blood
 Blood should be maintained at refrigerator temperature
at all times during storage
 the container should not be opened or punctured to
obtain a sample
 the recommended storage time must not be exceeded

19. Types of transfusion…..
Blood should be examined routinely for:
- unusual color or
- the presence of hemolysis, both of which may suggest bacterial
contamination.

20. Types of Transfusion…..
d. Circulatory overload
 Results from the transfusion of a patient with a
normal blood volume but a reduced RBCs no.
 The total circulatory volume becomes too great
for the pumping action of the heart
 Cause congestive heart failure manifested by:
 Coughing
 Cyanosis, and
 Difficulty in breathing

21. 10.2.Investigating a transfusion reaction
10.2.1.What should be done?
 Stop the transfusion immediately
 Saline is maintained in the IV line
 Physicians are notified
 Blood samples are sent to the lab only in cases
of:
 Acute HTR
 Anaphylaxis
 TRALI
 Bacterial contamination

22. 22
10.2.2. Laboratory tests to be done when
transfusion reaction occurs
1. Check the identification of the patient and transfused
unit
2. Obtain a post transfusion specimen from the patient and
visually examine it for hemolysis
3. Perform direct Antiglobulin test from post transfusion
sample, taken as soon as possible after the reaction
has taken place.
4. Re-type the RBCs of both donor and recipient for ABO
and Rh grouping.
5. Re-cross-match blood from each unit transfused using
serum from both pre-and post-transfusion specimens
from the patient.

23. References
1.Immunohematology for medical laboratory
science students,Yayehyirad T. and Misganaw
B., Upgraded lecture note.2008
2.Basic and applied concepts of
Immunohematology, 2nd ed. Kathy D.Blaney
and Paula R.Howard,2009
3. Blood banking and transfusion medicine: basic
principles and practice. Christopher D.Hilliyer et
al., 2nd ed.2007.
4.Safe blood donations, Module 1 WHO.2002
23

24. References…
5.Screening for HIV and other infectious agents,
Module 2, WHO. 2002
6.Blood group serology. Module 3 WHO.2002
7.Guidelines and principles for safe blood
transfusion practice, Introductory module. WHO
2002.
8.Immunohematology: Principles and Practice
Quinley. 2nd ed.1998.
9.AABB Technical Manual .15th Edition.2005
24