This document summarizes common transfusion reactions including acute hemolytic transfusion reaction (AHTR), delayed hemolytic transfusion reaction (DHTR), febrile non-hemolytic transfusion reaction (FNHTR), and transfusion-related acute lung injury (TRALI). It presents four case studies demonstrating these reactions and reviews their causes, presentations, diagnoses, and treatments. Key learning points are definitions of reaction types, the importance of proper patient identification to prevent AHTR, and the "two-hit" model of TRALI involving patient and donor factors.
Transfusion Medicine has evolved in last decade & many societies have given recommendations for safe transfusion practices. Compiling these recommendations is very useful academic & practical activity
Transfusion reactions are those reaction which is caused by the transfusion of blood or blood products at the time of transfusion or after completion of transfusion. each reaction should be consider serious.
Transfusion Medicine has evolved in last decade & many societies have given recommendations for safe transfusion practices. Compiling these recommendations is very useful academic & practical activity
Transfusion reactions are those reaction which is caused by the transfusion of blood or blood products at the time of transfusion or after completion of transfusion. each reaction should be consider serious.
Red cell and platelet storage lesions and their effect in transfusion practiseArjuna Samaranayaka
Bio mechanical and metabolic changes that occur in red cell concentrates and platelets during ex-vivo storage, their effect in transfusion practise and strategies to minimize them.
Autologous Blood Transfusion (ABT) means reinfusion of blood or blood products taken from the same patient
ABT is not a new concept, fear of transfusion- transmitted diseases stimulated the growth of autologous programme
Red cell and platelet storage lesions and their effect in transfusion practiseArjuna Samaranayaka
Bio mechanical and metabolic changes that occur in red cell concentrates and platelets during ex-vivo storage, their effect in transfusion practise and strategies to minimize them.
Autologous Blood Transfusion (ABT) means reinfusion of blood or blood products taken from the same patient
ABT is not a new concept, fear of transfusion- transmitted diseases stimulated the growth of autologous programme
COMPLICATIONS OF BLOOD TRANSFUSION BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR...Prof Dr Bashir Ahmed Dar
A blood product is any component of the blood which is collected from a donor for use in a blood transfusion. Whole blood is uncommonly used in transfusion medicine at present; most blood products consist of specific processed components such as red blood cells, blood plasma, or platelets.
Lorem ipsum dolor sit amet, voluptaria percipitur has eu. Nibh iriure nostrud ei mea. Vel dicta voluptua convenire ei, id pro libris viderer. Pri et legendos atomorum, vel eu noster probatus menandri. Omnes possim ut eam, sed ea labore maiorum.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Disclosures
• I have no financial relationships
related to this presentation.
• I will not be speaking about any
specific commercial product,
device, or medication.
• I will not be speaking of any off
label use of medications or
devices
3. Objectives
• State the transfusion
complication that is
prevented by transfusing
irradiated blood
components
• State the common root
cause of ABO hemolytic
transfusion reactions and
list 2 ways to prevent this
4. What will be covered?
Covered
• Acute
– AHTR
– FNHTR
– TRALI
– TACO
– Bacterial sepsis
• Delayed
– DHTR
Not Covered
• Acute
– Allergic
– Anaphylactic reactions
• Delayed
– Alloimmunization
– TA-GVHD
– Iron overload
– PTP
5. Case #1
• John R. Smith is a 71 year-old male admitted to
the cardiology unit for unstable angina
• PMH
– Coronary artery disease
» 2 vessel disease (LAD, RCA)
» s/p stents to both vessels
– Type II DM
» oral hypoglycemics
– Hypertension
– Hypercholesterolemia
7. Case #1
• Shortly after the 1st unit of RBC was started
– left lower back and abdominal pain
– temperature increased from 37.2°C to 39.8°C
– BP decreased from 130/75 mm Hg to 75/50 mm Hg
– urine – dark red
• Transfusion was stopped
• A new sample was sent to the blood bank
8. Blood Bank Evaluation
Pre-transfusion Post-transfusion
Clerical check OK OK
Plasma yellow red
DAT negative positive (C3d)
Antibody screen negative negative
Crossmatch compatible incompatible
Unit blood type A-positive A-positive
Patient blood type A-positive O-positive
10. Case #2
• 38 year-old female s/p hysterectomy for severe
abdominal pain and irregular vaginal bleeding
due to uterine fibroids unresponsive to other
therapy.
• PMH
– 2 prior pregnancies
– hypertension – well controlled
• Post-op day #2 she develops vaginal bleeding
12. Case #2
• Transfusion was uneventful
• Five days following the transfusion:
– temperature increased from 37.2°C to 38.2°C
– hemoglobin decreased from 8.9 g/dL to 7.1 g/dL
– urine – dark brown
– no other signs or symptoms
• A new sample was sent to the blood bank
13. Blood Bank Evaluation
Previous Evaluation Current Evaluation
Clerical check n/a n/a
Plasma yellow brown
DAT negative positive (IgG)
Antibody screen anti-E anti-E, anti-Jka
Unit blood type O-negative O-negative
Patient blood type O-negative O-negative
21. Laboratory Evaluation
• clerical check
• visual inspection of serum / plasma
• DAT
• repeat ABO (pre- and post-)
• as indicated:
– repeat antibody screen (pre- and post-)
– repeat antibody identification (pre- and post-)
– repeat crossmatch (pre- and post-)
– bilirubin, LDH, haptoglobin, urinalysis, etc.
researchdx.com
22. Treatment
• Stop the transfusion
• Supportive treatment for the patient
– Blood pressure support
– maintain urine output (> 1 mL/kg/hr)
– pain relief
• Report the reaction to the Blood Bank
• Blood for future transfusion
23. Prevention
• Event reporting system
• Proper patient identification
– when samples are drawn
– when blood transfused
• Proper labeling of samples at the bedside
• Special wristbands / electronic identification systems
• Two determinations of a patient’s blood type
• Proper laboratory technique and documentation
– meticulous attention to detail
– good judgment and critical thinking
24. Aftermath
• Wrong patient was drawn
– roommate was drawn instead of the patient
– patient was not properly identified prior to phlebotomy
• Patient died from complications following the
transfusion reaction.
25. Questions for Discussion
• What if the DAT had been negative on the post-
transfusion sample:
– Would that rule-out an AHTR?
– Why could the DAT be negative after an AHTR?
• Is it OK to allow the patient’s doctor to correct a
mislabeled blood bank specimen if they can
positively identify the tube and the patient?
26. AABB Technical Manual
“When a sample is received in the laboratory, a
trained member of the staff must confirm that the
information on the label and on the transfusion
request is identical. If there is any doubt about
the identity of the patient, a new sample must be
obtained. It is unacceptable for anyone to
correct identifying information on an
incorrectly labeled sample.”
Technical Manual, 15th edition. AABB Press, 2005
27. Delayed Hemolytic Transfusion
Reaction
• Incidence 1:5000 – 1:11,000
• Etiology
– anamnestic immune response to RBC antigen
– rapid production of new antibody (very rare)
– usually extravascular hemolysis
• Hemolytic vs serologic
• Most commonly involved antibody:
– anti-Jka
28. Timing of DHTR
0
20
40
60
80
100
120
140
1-7 8-14 15-21 22-28 29-35 36-42 43-49 >49
Days after Transfusion
NumberofCases
• Most occur within the first 2 weeks after transfusion
Davenport RD in Popovsky MA, ed. Transfusion Reactions, 4th ed; 2012
29. Clinical Presentation and Diagnosis
• Clinical Presentation
– fever
– decreasing hemoglobin
– jaundice
– new positive antibody screening test
• Laboratory Evaluation
– DAT
– antibody screen and identification
– tests for hemolysis
researchdx.com
30. Treatment and Prevention
• Treatment
– supportive care
– identify antibody
– transfuse compatible cells as needed
• Prevention
– prevention as for AHTR
– previous records
– honor all previously identified antibodies
– not always preventable
31. Case #3
• 62 year-old male with GI bleeding
• PMH
– Cirrhosis
» alcohol abuse
» esophageal varices
» coagulopathy
– COPD
» mild
» tobacco use
32. Case #3
• Laboratory Results
– Hgb = 6.5 g/dL (14.0-18.0 g/dL)
– Hct = 20% (42-52%)
– PT = 20.6 sec (11-14.5 sec)
– aPTT = 39.2 sec (24-36 sec)
• 2 units of RBC and 2 units of FFP are ordered
for transfusion
• Pretransfusion Evaluation
– patient’s blood type = A-positive
– patient’s antibody screen = negative
33. Case #3
• During 2nd unit of RBC
– temperature increased from 36.8°C to 38.5°C
– mild chills
– urine – clear yellow
– no other signs or symptoms
• Transfusion was stopped
• A new sample sent to the blood bank
34. Blood Bank Evaluation
Pre-transfusion Post-transfusion
Clerical check OK OK
Plasma yellow yellow
DAT negative negative
Antibody screen negative negative
Crossmatch compatible compatible
Unit blood type A-positive A-positive
Patient blood type A-positive A-positive
36. Incidence
• 0.1-1% of blood transfusions
• Multiple transfusions or pregnancies - risk
• Varies by component
– platelets 4.6%
– red cells 0.33%
– FFP – rare
37. Clinical Presentation
• Fever
– rise in temperature of ≥ 1ºC (2ºF)
– not explained by the patient’s clinical condition
– may be absent
• Chills / rigors / cold / discomfort
• Headache
• Nausea / vomiting
• Timing
– typically occur towards the end of the transfusion
– 5-10% occur 1-2 hours after the transfusion
38. Etiology
• Alloimmunization – WBC or platelets
– Antibodies in patient react with donor WBC or platelets
– Donor antibodies react with patient WBC or platelets
• Storage-related cytokines
– WBC-derived: IL-1β, IL6, IL8, TNFα, etc.
– Platelet-derived: CD154, CCL5, PF4, MIP1α, TGF-β1, etc.
www.sinobiological.com
41. Treatment and Prevention
• Treatment
– stop transfusion
– keep IV line open
– medication
» fever
» shaking chills
• Prevention
– leukoreduction of blood components
– premedication
– slower rate of infusion
– washing cellular components
42. Questions for Discussion
• What if the temperature increases by only:
– 1°F?
– 0°F?
• Should you send all these units out for culture?
• If the blood bank evaluation is negative can the
transfusion be restarted (does the unit have to
be discarded)?
43. Case #4
• 67 year-old male with GI bleed
• PMH
– h/o gastric ulcers
– h/o GI bleed x 2
– hypercholesterolemia
– coronary artery disease
» s/p angioplasty
» s/p stent placement (LAD, RCA)
44. Case #4
• Laboratory Results
– Hgb = 9.04 g/dL (14.0-18.0 g/dL)
– Hct = 27% (42-52%)
– Plt = 225,000/μL (130,000-400,000/ μL)
• 1 unit of RBC was ordered for transfusion
• Pretransfusion Evaluation
– patient’s blood type = O-negative
– patient’s antibody screen = negative
45. Case #4
• 45 minutes after the completion of the
transfusion the patient developed:
– severe shortness of breath (dyspnea)
– severe decrease in blood oxygen level (hypoxemia)
– low blood pressure (hypotension)
– temperature increased from 37.1°C to 38.5°C
• Chest x-ray – severe bilateral pulmonary edema
• A new sample was sent to the blood bank
46. Case #4
Amber Henry, MD, Darrell Triulzi, MD, and Mark Yazer, MD.
http://path.upmc.edu/cases/case509.html. May, 2007
Pre-transfusion Post-transfusion
47. Blood Bank Evaluation
Pre-transfusion Post-transfusion
Clerical check OK OK
Plasma yellow yellow
DAT negative negative
Antibody screen negative negative
Crossmatch compatible compatible
Unit blood type O-negative O-negative
Patient blood type O-negative O-negative
Clinical Evidence of Volume Overload (per patient’s MD): none
49. TRALI
•
• Incidence
– 1 : 1200–1 : 190,000 components transfused
Graph: Fatalities Reported to FDA Following Blood Collection and Transfusion: Annual
Summary for Fiscal Year 2014. www.fda.gov
50. Clinical Presentation
• Symptoms
– dyspnea
• CXR
– diffuse, bilateral
alveolar and interstitial
infiltrates
– no evidence of cardiac
failure
– no other cause for
pulmonary failure
• Signs
– tachypnea
– hypoxemia
– cyanosis
– fever ≥ 1°C
– hypotension
– rales
Occurring within 6 hours
of transfusion
51. Two-Hit Model
• First Hit
– Clinical status of the patient
» hematologic malignancy
» recent surgery (especially CPB)
» active infection or sepsis
» massive transfusion
» kidney and/or liver disease
52. Two-Hit Model
• Second Hit
– Transfusion of an activator
» antibody
» non-antibody
bioactive lipids
cytokines / cytokine receptors
other
58. Implicated Components
• All blood components have been implicated
• All types of anticoagulant / preservative solutions
have been implicated
• Leukoreduced units have been implicated
• IVIg
59. Prevention
• High plasma volume products from:
– Males
– Females with no history of pregnancy
– Females with a history of pregnancy who have been
tested and found negative for HLA antibodies
• Pooled solvent/detergent-treated (SD) plasma
• Platelets in platelet additive solutions
60. Plasma-Containing Components
• High plasma-volume components
– FFP
– plasma frozen within 24 hours after phlebotomy
– cryoprecipitate-reduced plasma
– apheresis platelets
– buffy-coat-derived platelets
– whole blood
• Lower plasma-volume components
– red blood cells
– platelets prepared from whole blood
– cryoprecipitate
61. Case #5
• 71 year-old male admitted with left lower lobe
pneumonia
• PMH
– Coronary artery disease
» s/p CABG x 3 – 5 years ago
» h/o CHF
– COPD
» moderate
» quit smoking – 15 years ago
– Type II Diabetes Mellitus – oral hypoglycemic
62. Case #5
• Laboratory Results
– Hgb = 7.2 g/dL (14.0-18.0 g/dL)
– Hct = 22% (42-52%)
• 3 units of RBC are ordered for transfusion
• Pretransfusion Evaluation
– patient’s blood type = A-positive
– patient’s antibody screen = negative
63. Case #5
• 15 minutes after transfusion of the 3rd unit of
RBC the patient developed shortness of breath
– decreased blood oxygen level
– blood pressure increased slightly
– developed a cough productive of white sputum
64. Case #5
• Further patient evaluation:
– I/O = 2250 / 575 cc
• Treatment:
– furosemide 60 mg IV
• Response to treatment:
– patient responded with 1250 cc of urine output
– shortness of breath improved significantly
70. Case #6
• John D. Smyth is a 67 year-old male admitted
for acute myelogenous leukemia.
• PMH
– Acute myelogenous leukemia
» s/p induction induction chemotherapy
» pancytopenic
– Hypertension
– Hypercholesterolemia
72. Case #6
• Shortly after the transfusion was started
– temperature increased from 37.2°C to 40.1°C
– rigors developed
– patient became hypotensive (BP = 70/42 mmHg)
• Transfusion was stopped
• A new sample was sent to the blood bank
73. Blood Bank Evaluation
Pre-transfusion Post-transfusion
Clerical check OK OK
Plasma yellow yellow
DAT negative negative
Antibody screen negative negative
Crossmatch N/A N/A
Unit blood type A-positive A-positive
Patient blood type A-positive A-positive
Gram stain platelet unit = gram-negative rods
79. Diagnosis
• Differential Diagnosis
– hemolytic transfusion reaction
– FNHTR
– TRALI
– underlying disease
• Blood Bank Evaluation
– rule-out hemolysis
– gram stain and culture of unit in question
– blood cultures from the patient
80. Prevention
• Appropriate transfusion of blood components
• All components
– blood donor screening
– skin disinfection prior to venipuncture
– diversion of the first 30-50 cc of blood from collection
• Platelet-specific
– single-donor (apheresis) platelets
– reducing storage duration
– bacterial detection
» culture-based
» rapid immunoasay
– pathogen inactivation
81. Component Modifications
Modification Decreases risk of or prevention of….
Leukoreduction CMV infection
FNHTR
alloimmunization
reperfusion injury in CABG
Irradiation TA-GVHD
Washing anaphylcatic reactions
recurrent allergic reactions
recurrent FNHTR
82. Who should get irradiated blood?
• Clearly at risk:
– BMT (allo and auto)
– Congenital immune deficiency
syndromes
– Intrauterine transfusions
– Neonatal exchange
transfusions
– Hodgkin’s disease
– Directed donations from blood
relatives
– HLA-matched transfusions
– Granulocyte transfusions
– Patients treated with purine
analogue drugs (e.g.
fludarabine)
• Possibly at risk:
– Acute leukemia
– Non-Hodgkin’s lymphoma
– Low birthweight infants
– Extensive chemotherapy/XRT
for solid tumors
– Solid organ transplants
– ECMO
• Not at risk:
– HIV / AIDS
83. Objectives
• State the transfusion
complication that is
prevented by transfusing
irradiated blood components
• State the common root
cause of ABO hemolytic
transfusion reactions and list
2 ways to prevent this
TA-GVHD
Clerical error
- proper patient identification
- proper labeling of samples at the bedside
- special wristbands / electronic identification systems
- requiring second sample for determining blood type
84. Any questions?
Any answers?
Any rags, any bones,
any bottles today?
- Professor Quincy Adams Wagstaff,
President, Huxley College, 1932.
Perelman SJ, Kalmar B, Ruby H, Johnstone WB. The Four Marx
Brothers - Horse Feathers. Paramount Pictures (1932)