This document discusses complications that can occur from blood transfusions. It describes various types of acute and delayed transfusion reactions, including immune and non-immune causes. Acute reactions include hemolytic, allergic, febrile non-hemolytic, circulatory overload, transfusion-related acute lung injury (TRALI), and bacterial contamination reactions. Delayed reactions include delayed hemolytic reactions, post-transfusion purpura, graft-versus-host disease, hemosiderosis, and transfusion-transmitted infections. The document provides details on the mechanisms, signs and symptoms, diagnoses, and treatments for each of these complications. It emphasizes the importance of proper identification of patients and blood products to prevent transfusion
Complications of blood transfusions, blood transfusion is a life saving and life threating procedure, so it's important to anticipate blood transfusion reaction
ADVERSE EFFECTS OF BLOOD TRANSFUSION.pptxdipyapatho
Adverse transfusion reactions:Adverse transfusion reactions are unwanted or harmful responses that can occur as a result of receiving a blood transfusion. While blood transfusions are generally safe, adverse reactions can happen in some cases. Here are some common types of adverse transfusion reactions in the presentation
This document discusses non-infectious transfusion reactions, classifying them as acute or delayed, and immunologic or non-immunologic. It describes hemolytic transfusion reactions, their signs and symptoms, complications, and immediate management. It also covers urticarial and anaphylactic reactions, as well as bacterial contamination of blood products. Methods to prevent errors in the transfusion process and reactions are outlined.
This document provides information about blood transfusion and transfusion reactions. It discusses the types of whole blood and blood components that can be transfused, including red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. It describes the indications for different blood component transfusions. The document also outlines the important tests that must be performed prior to transfusion, including blood typing and antibody screening. Finally, it examines the various types of transfusion reactions that can occur, including acute hemolytic, febrile, allergic, and delayed hemolytic reactions, as well as TRALI and TACO. It provides the signs, symptoms, and management of each type of reaction.
This document discusses blood transfusion and transfusion reactions. It begins by defining blood transfusion as transferring blood products from a donor to a recipient intravenously. It then outlines the purposes and types of transfusions, including whole blood, red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. The document also covers pre-transfusion testing, potential transfusion reactions including hemolytic, febrile, allergic, and delayed hemolytic reactions, and how to manage acute reactions.
Transfusion reactions can occur during or after blood transfusion and range from mild to life-threatening. The major causes are misidentification of patient, blood or sample, or administration errors. Reactions can be infectious, from pathogens in blood, or non-infectious, which include immune reactions (e.g. hemolytic), non-immune reactions (e.g. transfusion-associated circulatory overload), or errors in storage or administration (e.g. hypothermia, hyperkalemia, citrate toxicity). Treatment depends on the type of reaction but may include stopping transfusion, supportive care, and addressing specific causes.
Complications of blood transfusions, blood transfusion is a life saving and life threating procedure, so it's important to anticipate blood transfusion reaction
ADVERSE EFFECTS OF BLOOD TRANSFUSION.pptxdipyapatho
Adverse transfusion reactions:Adverse transfusion reactions are unwanted or harmful responses that can occur as a result of receiving a blood transfusion. While blood transfusions are generally safe, adverse reactions can happen in some cases. Here are some common types of adverse transfusion reactions in the presentation
This document discusses non-infectious transfusion reactions, classifying them as acute or delayed, and immunologic or non-immunologic. It describes hemolytic transfusion reactions, their signs and symptoms, complications, and immediate management. It also covers urticarial and anaphylactic reactions, as well as bacterial contamination of blood products. Methods to prevent errors in the transfusion process and reactions are outlined.
This document provides information about blood transfusion and transfusion reactions. It discusses the types of whole blood and blood components that can be transfused, including red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. It describes the indications for different blood component transfusions. The document also outlines the important tests that must be performed prior to transfusion, including blood typing and antibody screening. Finally, it examines the various types of transfusion reactions that can occur, including acute hemolytic, febrile, allergic, and delayed hemolytic reactions, as well as TRALI and TACO. It provides the signs, symptoms, and management of each type of reaction.
This document discusses blood transfusion and transfusion reactions. It begins by defining blood transfusion as transferring blood products from a donor to a recipient intravenously. It then outlines the purposes and types of transfusions, including whole blood, red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. The document also covers pre-transfusion testing, potential transfusion reactions including hemolytic, febrile, allergic, and delayed hemolytic reactions, and how to manage acute reactions.
Transfusion reactions can occur during or after blood transfusion and range from mild to life-threatening. The major causes are misidentification of patient, blood or sample, or administration errors. Reactions can be infectious, from pathogens in blood, or non-infectious, which include immune reactions (e.g. hemolytic), non-immune reactions (e.g. transfusion-associated circulatory overload), or errors in storage or administration (e.g. hypothermia, hyperkalemia, citrate toxicity). Treatment depends on the type of reaction but may include stopping transfusion, supportive care, and addressing specific causes.
Indications and complications of blood transfusion abhimanyu_ganguly
Blood transfusions are given to increase oxygen-carrying capacity and intravascular volume. Transfusion is rarely indicated when hemoglobin is above 10 g/dL but is almost always needed below 6 g/dL, with determinations between 6-10 g/dL based on patient risk and evaluation. Complications include changes in oxygen transport, coagulation issues like thrombocytopenia, allergic reactions, lung injury, and immunosuppression. The most common causes of transfusion-related death are bacterial contamination, transfusion-related acute lung injury, and mistransfusion.
Blood transfusions have evolved significantly since the first animal-to-human transfusion in 1665. Key developments include the discovery of blood groups by Landsteiner in 1901, which helped reduce transfusion reactions. Major risks of transfusion include febrile reactions, allergic reactions, respiratory complications like TRALI, and rare but serious events like hemolytic reactions and disease transmission. Proper screening and typing has made transfusions much safer, but complications remain a risk, especially with massive transfusions required for trauma patients. Researchers continue working on blood substitutes to reduce donor dependence and risks of allogeneic transfusion.
The document discusses hemolytic transfusion reactions, including clinical features, workup, and classification. It provides details on:
- Immediately stopping the transfusion, clerical checks, and laboratory tests to check for hemolysis like hemoglobinemia, DAT, and LDH.
- Acute hemolytic transfusion reactions within 24 hours can cause fever, hypotension, hemoglobinuria, and are treated with hydration. Delayed reactions over 24 hours are usually milder and extravascular.
- Thorough testing, labeling, and advanced identification methods can help prevent hemolytic transfusion reactions.
Blood transfusion practices involve determining a patient's blood type and screening for antibodies to reduce risks of transfusion reactions like hemolytic reactions. Key indications for transfusion include maintaining hemoglobin above 6-8 g/dL and allowing blood loss within established volumes. Complications can be minimized through proper blood type matching, leukoreduction, and following guidelines for transfusion thresholds and volumes.
4. Blood and blood product transfusion and complications.pptxRebiraWorkineh
Blood transfusion is an integral part of medical treatment but carries risks of complications. Acute transfusion reactions include hemolytic reactions which can be fatal if incompatible blood is transfused, febrile reactions caused by antibodies to HLA antigens, and allergic reactions treated with antihistamines. Chronic risks include alloimmunization against minor antigens, transfusion-associated graft-versus-host disease which is usually fatal, and transmission of infections like hepatitis and HIV without proper screening. Hospitals have protocols to properly screen and match blood and monitor for complications during and after transfusions.
Blood transfusion involves transferring blood or blood components from a donor to a recipient. There are several types of blood transfusions including whole blood transfusion and transfusion of individual blood components like red blood cells, platelets, and plasma. Blood transfusions can cause various complications such as transfusion-related acute lung injury (TRALI), febrile nonhemolytic reactions, allergic reactions, hemolytic reactions if there is an ABO incompatibility, infections transmitted through the blood, and transfusion-associated circulatory overload (TACO). It is important to carefully screen and type donor blood and properly match it to the recipient to reduce risks of complications from blood transfusions.
Pocket guide on red cells (Blood Transfusion) 2012Pavan Lomati
This document provides guidelines for red blood cell transfusion from the American Society of Hematology. It discusses appropriate indications for RBC transfusion including treatment of symptomatic anemia and restoration of oxygen-carrying capacity. It also covers major RBC products, pretransfusion testing to ensure compatibility, special processing of RBCs, and guidelines for emergency release of blood products when testing cannot be completed due to a life-threatening situation. The goal is to provide safe and effective transfusion support while avoiding adverse immunological reactions.
This document discusses various blood products and their uses. It describes that whole blood contains plasma and cellular components. Packed red blood cells contain 50-70% hematocrit after removal of platelets and plasma, and are used for trauma with acute blood loss over 20% or symptomatic anemia without clotting defects. Platelets are used for bleeding due to thrombocytopenia or platelet dysfunction. Fresh frozen plasma contains clotting factors and is used for single or multiple coagulation factor deficiencies. Complications of blood transfusion include infectious issues like bacterial contamination and non-infectious issues such as acute hemolytic transfusion reactions, allergic reactions, circulatory overload and iron overload.
This document provides an overview of blood transfusion in surgery. It discusses the history of blood transfusion, the components of blood, indications for transfusion, complications of transfusion such as reactions and infections, massive blood transfusion protocols, and current trends. The document outlines the various blood products that can be transfused including red blood cells, platelets, plasma, and cryoprecipitate. It also discusses autologous and allogenic transfusion approaches.
This document provides information about blood transfusion, including guidelines, components, and risks. It discusses:
1) Guidelines from 1988 and 2010 that multiple factors should be considered for red blood cell transfusion based on a patient's clinical status and oxygen needs.
2) Red blood cell transfusion is indicated for symptomatic anemia, life-threatening anemia, or restoring oxygen-carrying capacity after hemorrhage.
3) Potential transfusion reactions include febrile non-hemolytic reactions, acute hemolytic reactions, transfusion-related acute lung injury, and infections like HIV or hepatitis. Careful patient screening and component selection can reduce risks.
This document summarizes complications of blood transfusion, including immediate and delayed immunologic and non-immunologic complications. Immunologic complications include acute hemolytic transfusion reactions, febrile nonhemolytic transfusion reactions, allergic/anaphylactic reactions, TRALI, delayed hemolytic transfusion reactions, and TA-GVHD. Non-immunologic complications include transfusion-transmitted infections, TACO, iron overload, and complications related to massive transfusion.
This document discusses complications that can occur from blood transfusions. It describes various types of immunologic reactions like acute and delayed hemolytic reactions, febrile non-hemolytic reactions, allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, and post-transfusion purpura. It also discusses infectious complications from transfusions like viruses, bacteria, and other pathogens. Massive blood transfusions are outlined as carrying additional risks such as acidosis, hyperkalemia, citrate toxicity, hypocalcemia, metabolic alkalosis, iron overload, fluid overload, and hypothermia. Prevention strategies and treatment approaches for various complications are provided.
This document provides an overview of transfusion reactions, including their classification and management. It discusses acute hemolytic reactions caused by ABO incompatibility. It also covers febrile non-hemolytic reactions, allergic reactions, anaphylaxis, transfusion-associated circulatory overload, post-transfusion purpura, graft-versus-host disease, and infectious complications including bacterial and viral transmission. Prevention strategies and treatment approaches are described for each type of transfusion reaction.
This document discusses the hazards associated with blood transfusions. It outlines both immunological complications like hemolytic reactions and febrile reactions as well as non-immunological complications such as infections, fluid overload, and metabolic issues. It provides details on specific complications including their incidence rates, symptoms, management, and methods for prevention. While transfusion hazards can never be entirely eliminated, the risks are relatively low compared to everyday risks and have decreased with improved practices around donor selection, testing, and education.
This document summarizes potential complications that can arise from blood transfusions. It discusses immune complications such as hemolytic reactions (acute and delayed) and non-hemolytic reactions (febrile, urticarial, etc.). It also covers non-immune complications associated with massive blood transfusions (coagulopathy, citrate toxicity, hypothermia) and infectious agents that can potentially be transmitted (hepatitis, HIV, CMV). Throughout, it provides details on symptoms, management, and testing procedures for various transfusion complications.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Indications and complications of blood transfusion abhimanyu_ganguly
Blood transfusions are given to increase oxygen-carrying capacity and intravascular volume. Transfusion is rarely indicated when hemoglobin is above 10 g/dL but is almost always needed below 6 g/dL, with determinations between 6-10 g/dL based on patient risk and evaluation. Complications include changes in oxygen transport, coagulation issues like thrombocytopenia, allergic reactions, lung injury, and immunosuppression. The most common causes of transfusion-related death are bacterial contamination, transfusion-related acute lung injury, and mistransfusion.
Blood transfusions have evolved significantly since the first animal-to-human transfusion in 1665. Key developments include the discovery of blood groups by Landsteiner in 1901, which helped reduce transfusion reactions. Major risks of transfusion include febrile reactions, allergic reactions, respiratory complications like TRALI, and rare but serious events like hemolytic reactions and disease transmission. Proper screening and typing has made transfusions much safer, but complications remain a risk, especially with massive transfusions required for trauma patients. Researchers continue working on blood substitutes to reduce donor dependence and risks of allogeneic transfusion.
The document discusses hemolytic transfusion reactions, including clinical features, workup, and classification. It provides details on:
- Immediately stopping the transfusion, clerical checks, and laboratory tests to check for hemolysis like hemoglobinemia, DAT, and LDH.
- Acute hemolytic transfusion reactions within 24 hours can cause fever, hypotension, hemoglobinuria, and are treated with hydration. Delayed reactions over 24 hours are usually milder and extravascular.
- Thorough testing, labeling, and advanced identification methods can help prevent hemolytic transfusion reactions.
Blood transfusion practices involve determining a patient's blood type and screening for antibodies to reduce risks of transfusion reactions like hemolytic reactions. Key indications for transfusion include maintaining hemoglobin above 6-8 g/dL and allowing blood loss within established volumes. Complications can be minimized through proper blood type matching, leukoreduction, and following guidelines for transfusion thresholds and volumes.
4. Blood and blood product transfusion and complications.pptxRebiraWorkineh
Blood transfusion is an integral part of medical treatment but carries risks of complications. Acute transfusion reactions include hemolytic reactions which can be fatal if incompatible blood is transfused, febrile reactions caused by antibodies to HLA antigens, and allergic reactions treated with antihistamines. Chronic risks include alloimmunization against minor antigens, transfusion-associated graft-versus-host disease which is usually fatal, and transmission of infections like hepatitis and HIV without proper screening. Hospitals have protocols to properly screen and match blood and monitor for complications during and after transfusions.
Blood transfusion involves transferring blood or blood components from a donor to a recipient. There are several types of blood transfusions including whole blood transfusion and transfusion of individual blood components like red blood cells, platelets, and plasma. Blood transfusions can cause various complications such as transfusion-related acute lung injury (TRALI), febrile nonhemolytic reactions, allergic reactions, hemolytic reactions if there is an ABO incompatibility, infections transmitted through the blood, and transfusion-associated circulatory overload (TACO). It is important to carefully screen and type donor blood and properly match it to the recipient to reduce risks of complications from blood transfusions.
Pocket guide on red cells (Blood Transfusion) 2012Pavan Lomati
This document provides guidelines for red blood cell transfusion from the American Society of Hematology. It discusses appropriate indications for RBC transfusion including treatment of symptomatic anemia and restoration of oxygen-carrying capacity. It also covers major RBC products, pretransfusion testing to ensure compatibility, special processing of RBCs, and guidelines for emergency release of blood products when testing cannot be completed due to a life-threatening situation. The goal is to provide safe and effective transfusion support while avoiding adverse immunological reactions.
This document discusses various blood products and their uses. It describes that whole blood contains plasma and cellular components. Packed red blood cells contain 50-70% hematocrit after removal of platelets and plasma, and are used for trauma with acute blood loss over 20% or symptomatic anemia without clotting defects. Platelets are used for bleeding due to thrombocytopenia or platelet dysfunction. Fresh frozen plasma contains clotting factors and is used for single or multiple coagulation factor deficiencies. Complications of blood transfusion include infectious issues like bacterial contamination and non-infectious issues such as acute hemolytic transfusion reactions, allergic reactions, circulatory overload and iron overload.
This document provides an overview of blood transfusion in surgery. It discusses the history of blood transfusion, the components of blood, indications for transfusion, complications of transfusion such as reactions and infections, massive blood transfusion protocols, and current trends. The document outlines the various blood products that can be transfused including red blood cells, platelets, plasma, and cryoprecipitate. It also discusses autologous and allogenic transfusion approaches.
This document provides information about blood transfusion, including guidelines, components, and risks. It discusses:
1) Guidelines from 1988 and 2010 that multiple factors should be considered for red blood cell transfusion based on a patient's clinical status and oxygen needs.
2) Red blood cell transfusion is indicated for symptomatic anemia, life-threatening anemia, or restoring oxygen-carrying capacity after hemorrhage.
3) Potential transfusion reactions include febrile non-hemolytic reactions, acute hemolytic reactions, transfusion-related acute lung injury, and infections like HIV or hepatitis. Careful patient screening and component selection can reduce risks.
This document summarizes complications of blood transfusion, including immediate and delayed immunologic and non-immunologic complications. Immunologic complications include acute hemolytic transfusion reactions, febrile nonhemolytic transfusion reactions, allergic/anaphylactic reactions, TRALI, delayed hemolytic transfusion reactions, and TA-GVHD. Non-immunologic complications include transfusion-transmitted infections, TACO, iron overload, and complications related to massive transfusion.
This document discusses complications that can occur from blood transfusions. It describes various types of immunologic reactions like acute and delayed hemolytic reactions, febrile non-hemolytic reactions, allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, and post-transfusion purpura. It also discusses infectious complications from transfusions like viruses, bacteria, and other pathogens. Massive blood transfusions are outlined as carrying additional risks such as acidosis, hyperkalemia, citrate toxicity, hypocalcemia, metabolic alkalosis, iron overload, fluid overload, and hypothermia. Prevention strategies and treatment approaches for various complications are provided.
This document provides an overview of transfusion reactions, including their classification and management. It discusses acute hemolytic reactions caused by ABO incompatibility. It also covers febrile non-hemolytic reactions, allergic reactions, anaphylaxis, transfusion-associated circulatory overload, post-transfusion purpura, graft-versus-host disease, and infectious complications including bacterial and viral transmission. Prevention strategies and treatment approaches are described for each type of transfusion reaction.
This document discusses the hazards associated with blood transfusions. It outlines both immunological complications like hemolytic reactions and febrile reactions as well as non-immunological complications such as infections, fluid overload, and metabolic issues. It provides details on specific complications including their incidence rates, symptoms, management, and methods for prevention. While transfusion hazards can never be entirely eliminated, the risks are relatively low compared to everyday risks and have decreased with improved practices around donor selection, testing, and education.
This document summarizes potential complications that can arise from blood transfusions. It discusses immune complications such as hemolytic reactions (acute and delayed) and non-hemolytic reactions (febrile, urticarial, etc.). It also covers non-immune complications associated with massive blood transfusions (coagulopathy, citrate toxicity, hypothermia) and infectious agents that can potentially be transmitted (hepatitis, HIV, CMV). Throughout, it provides details on symptoms, management, and testing procedures for various transfusion complications.
Similar to Complications of Blood Transfusion Dr. Ankur K. Agarwal.pptx (20)
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Complications of Blood Transfusion Dr. Ankur K. Agarwal.pptx
1. Dr. Ankur K. Agarwal
MS, MCh Cambridge, UK
Assistant Professor
Complications of Blood
Transfusion
7/6/2023
2. Introduction
Like drugs, transfusion has primary and secondary adverse
reactions.
Blood and blood products can be considered as an double
edge sword.
The risks of transfusion are high as compared to other
medications.
Any person who administers a blood product has to know
about transfusion reactions and to prevent and treat
them.
Immediate or delayed
First thing to do: immediately STOP the transfusion
6. ATR : Acute haemolytic reactions
(1)
Causes :
– Immune-mediated lysis (intravascular or extravascular) of
transfused red cells,
– Transfusion of incompatibles red cells to a recipient who has
previously performed Ab to red cell surface Ag (anti-A, anti-B)
– Patient misidentification
– Within minutes of start of Tf,
– Recipient Ab activates Complement (anti-A/anti-B, IgM)
activation C9 intravascular haemolysis (C5-9
component, membrane attack complex) osmotic lysis
– haemoglobinemia et haemoglobinuria
9. Clinical signs :
– Shock, Hypotension and Bronchospasm (complement
fragments, anaphylatoxins C3a et C5a and other mediators of
inflammation)
– Renal ischaemia Tubular necrosis acute renal failure
– Cytokines network: IL1, IL6, IL8 et TNF fever, hypotension,
leucocytes and coagulation activation
– Activation of coagulation cascade DIC (disseminated
intravascular coagulation)
ATR : Acute haemolytic reaction
(1)
10. Severity :
– Depends of amount of blood transfused
– And the transfusion rate
– !!!!! Faster the insfusion rate, the more severe the reaction.
ATR : Acute haemolytic reaction
(1)
11. Not a transfusion reaction but can be confused with HTR in the
transfused patient
–Induction of neo-antigen on red cell membrane or Formation of
immunes complex that deposit on red cell surface, rarely autoAb to
red cells accelerated clearance
–Both autologous and transfused cells eliminated
–Positive direct antiglobin test, only in the presence of the drug
–May be severe, even fatal
–Treatment : stop drugs, transfusion, supportive care
–Drugs implicated : cephalosporin, cefotetan, ceftriaxone….
ATR: Drug-induced haemolysis
(2)
13. = mechanical
– Artificial heart valves,
– Extracorporeal circulation
– Transfusion through small-bore catheters under high pressure
– Osmotic lysis : hypotonic saline solutions, 5% dextrose in
water, distilled water, certain medication
– Heating > 42°C
– Freezing (haemolyse prior transfusion)
– haemoglobinuria may occur but not associated with shock…
ATR: Nonimmune haemolysis
(3)
14. – Fever
– Results from pyrogenes production (IL-1, IL-6, TNFa)
– FNHTR definition : > 1°C rise in the 2 hours following Tf
– 1 à 10 % of patients
– Ab directed against transfused leukocytes and platelets Ag-Ab
reaction pyrogens from plasmocytes
– Use leucocyte-reduced blood component
ATR: Febrile Nonhaemolytic
Transfusion Reaction (4)
15. – 1% of transfusion recipients
– Cause: Ag-Ab reactions (infusion of plasma proteins)
– Symptoms : cutaneous (urticaria, flushing, itching) + nausea,
vomiting, diarrhea, brochospasm
– Not dose-related
– Generally mild, not recurrent and responding to antiH1
– Anaphylactic reactions rarely : Ab to IgA, haptoglobin or C4
(Chido/Rogers blood group Ag)
– Consider washed blood component, high dose CS and
antiH1
ATR: Allergic reactions (5)
16. TACO: Transfusion Associated Circulatory Overload
– Patient unable to compensate for expanded blood
volume
– Signs = headache, dyspnea, pulmonary oedema,
congestive heart failure, systolic HTA
– Stop transfusion
– Prevention : rate of infusion 2 à 4 ml/Kg/h
– !!! Do not exceed 4 hours
ATR: Circulatory overload (6)
17. – Non cardiogenic pulmonary oedema
– Incidence 0.08 to 15%
– Cause : Two-hit model
– First hit: underlying patient factors activation of
pulmonary endothelium accumulation and adherence of
primed neutrophils in lungs
– Second hit: mediators in the blood transfusion activation
of pulmonary neutrophils capillary leakage and pulmonary
oedema
– Second hit can be antibody (passive transfer af HLA or
antileukocytes Ab) or Non Ab-mediated (accumulation of
proinflammatory mediators during storage)
– Donor often multiparous woman
ATR: Transfusion-Related Acute
Lung Injury (TRALI) (7)
20. – TRALI = respiratory distress, hypoxia, fever, bilateral pulmonary
oedema during or within 6 hours of a transfusion
– Patients at risk: cardiac surgery, sepsis, massive transfusion,
induction chaemo
– Supportive treatment. Steroids
– Resolution within 48 to 72 hours
– But : mortality ± 10%
– Give leukocytes-reduced components
– Report to blood bank
– Diagnosis: detection of HLA and leukocytes Ab in donor plasma, HLA
Ag typing of the recipient
ATR: Transfusion-Related Acute
Lung Injury (TRALI) (7)
21. – After platelets transfusion (or red cells)
– Bradykinines generation (contact of plasma with artificial surfaces
vasodilatation hypotension
– Stop transfusion rapid resolution
– Rare until prestorage leukocyte reduction
– Seen in patients treated with ACE inhibitory drugs (inhibition of
kinikinase II)
ATR: Hypotensive reaction to
transfusion (8)
22. – Rate of contamination 0.3%, less serious reactions
– Contamination during phlebotomy
– !!! Platelets conserved at ± 22°C
– Skin flora (Staphylococcus, Klebsiella, Escherichia)
– Clinical signs : fever, dyspnea, hypotension, shock
– Stop transfusion
– Supportive care and broad spectrum antibiotic
– Report immediately to blood bank (additional components must
be recalled)
ATR: Bacterial contamination (9)
23. – Hypothermia (refrigerator storage) arrythmia
– Over-warming blood haemolysis
– Use a monitored blood warming system when needed
ATR: Thermal effects (10)
24. – Citrate = Calcium chelation circumoral and fingers paresthesia
– Reversible leakage of K during storage hyperkaliemia (rare)
– Inconsequential EXCEPT: neonates (exchange transfusion), liver
transplantation, pediatric cardiac surgery and renal failure
– Washing red blood cells, use of blood less than 7 days old
ATR: Metabolic complications (11)
25. Medical emergency !
– Stop transfusion
– Verify the correct unit was given to the correct patient
– Maintain IV access, blood pressure, pulse and diuresis
– Maintain adequate oxygenation
– Notify attending physician and blood bank, consult with blood
bank physician before futher transfusion
– Return unit or empty bag to blood bank
– Obtain blood/urine for analyses
– Monitor signs of haemolysis, coagulation and renal status,
monitor Hb and Ht, repeat compatibility testing (crossmatch),
analyse urine for haemoglobinuria
– If bacterial contamination suspected: blood culture of patient
and unit, initiate broad spectrum antibiotics.
ATR : Work up and Treatment
26. Analyses at the blood bank :
– Ensure correct blood component transfused to the right patient
– Plasma visually evaluated for haemoglobinemia
– Post-transfusional sample : Direct Coombs
– Pre-transfusionnal sample: RAI, ABO, Rh and crossmatch tests
ATR: work-up
29. DTR : Delayed haemolytic reaction
(1)
Causes :
– Induction of Ab days or weeks after a transfusion by transfused
red cells.
• Appearance days after Tf,
anamnestic response
• Appearance weeks after Tf,
primary response.
– For each transfusion, 1-1.6% risk of sensitizing a recipient to a red
cell Ag other than D
– Most DHR extravascular
30. Symptoms :
– Less severe than Acute HR (no complement activation)
– Clinical signs : fever, malaise, fatigue et symptoms in relation with
anemia.
– Positive DAT
– Regenerative anemia and indirect hyperbilirubinemia
– Increased LDH and decreased haptoglobin
– Rare haemoglobinemia
DTR : Delayed haemolytic reaction
(1)
31. Implicated Ab :
– Duffy (Fya, Fyb) et Kidd (Jka, Jkb) systems
– Less intensive complement activation, delayed reaction
– Sometimes seen in ABO incompatibility
Prevention:
High-dose IVIg (400 mg/kg)
DTR : Delayed haemolytic reaction
(1)
33. Acute versus Delayed haemolytic
reaction
Type Signs & symptoms Usual cause Traitment Prevention
haemoglobinemia
ABO
incompatibility
Or other
complement-
fixing red cell
antibody
Stop transfusion,
hydrate, support
blood pressure
and respiration,
induce diuresis,
treat shock and
DIC if present
haemoglobinuria
haemolytic
Intravascular
(immune origin)
Fever, chills
Anxiety
Shock, dyspnea
Ensure proper
sample and
recipient
identification
Oliguria
Flank pain
haemolytic
extravascular
(immune origin)
Fever,
Malaise,
Indirect
hyperbilirubinemia,
increased LDH, urine
urobilinogen,
Falling haematocrit
IgG non-
complement
fixing Ab (anti-
Rhésus, anti-
Kell…)
Monitor Ht, renal
and hepatic fct,
coagulation
profile, no acute
treatment
generally
required
Review historical
records; ensure
proper
identification, give
Ag-negative units,
High-dosis IVIg
34. DTR: Post transfusionnel Purpura (2)
– Thrombocytopenia 1 to 3 weeks after transfusion.
– Allo-Ab anti-platelets (anti-HPA1).
– Diagnostic : Ab detection.
– Spontaneous resolution after 2 to 3 weeks.
– Traitment adapted to risk of haemorrhage:
• Low risk: wait and see
• High risk : -globulines (400-500 mg/kg), Plasmapheresis, platelet
transfusion.
35. DTR : GvHD (Graft versus Host Disease)(3)
– Transfusion of immuno-competent lymphocytes to immunodeficient
recipient
– Or transfusion of blood products from HLA-homozygous donor to
immunodeficient HLA-heterozygous recipients(familial donor).
– Donor lymphocytes engraft and recognize host histocompatibility Ag and
attack host tissues.
– 10-12 days after transfusion,
– Clinical signs : fever, cutaneous rash, diarrhea, hepatitis, marrow aplasia.
– Fatal in most cases.
– Prevention : IRRADIATION of blood and cellular components (2500cGy).
36. DTR : Immune modulation (4)
– Alteration in the recipient immune system after transfusion.
– sometimes :
• Beneficial (ex: prolongation of renal allograft survival or
prevention of spontaneous abortion)
• Deleterious : increased risk of tumor recurrence and post-
operative bacterial infections
– Relationship unproven.
37. DTR : haemosiderosis (5)
– 1 mL of red cells contain 1 mg of Iron.
– A unit of RBC: 150-250 mg of Iron.
– Iron accumulation organ damage (heart, liver pancreatic islets)
– Phlebotomy (after HSCT)
– parenteral (deferoxamine) or enteral (exjade) chelation
38. DTR : Air embolism (6)
– Rare with conventional transfusion techiques.
– May occur with blood pomps and apheresis machines
– Fatal risk of 1/30000 after readministration of recovered blood. In
cardiac surgery
– Complication : acute cardio-pulmonary failure, cyanosis, dolor,
cough, arythmia, shock, cardiac arrest.
– Traitment : place the patient head-down on the left side
39. DTR : Transfusion transmitted-disease (7)
– Allogeneic blood donation tested for : HBsAg, HBcAb, HCV-Ab,
HIV-Ab (1+2), HIV-Agp24, HTLV, syphilis.
– Methods : serologic + NAT.
– Residual risk: the « window period »
– 12 days for VIH
– 10 days for HCV
– 51 days for HTLV
– 38 days for HbS Ag
40. Prions Variant Creutzfeldt-Jakob
Chronic Wasting Disease (CWD)
Arbovirose West Nile virus
Dengue
Chikungunya
Other arbovirus
Other emergent virus in
transfusion
Humen herpes virus 8 (HHV-8)
Erythrovirus B-19
HAV – HEV
Influenza A/H5N1
Retrovirussimiens
Other
41. Transfusion risk per infused red unit
Risk 10 -2 10 -3 10 -4 10 -5 10 -6 10 -7 10 -8 0
High
HIV Paludism
HCV Variant MCJ
Bacteral contam GVHD
ABO Incompat Anaphylact.shock
Acute H. ABO
Middle
CMV Other bacterial
Delayed H PPT HPA-Ab Other parasites
HBV HTLV
Moderate
Febrile R Other virus Syphilis
allergic R
Low
Imm. Erythroc. anti-HPA Ab
anti-HLA Ab
10 -2 10 -3 10 -4 10 -5 10 -6 10 -7 10 -8 0
Immunological Risk Infectious risk J-Y Py, Réanimation 12 (2003) 564-574
42. Microparticles
• Submicron-sized fragments of cells’ plasma membranes
released in the supernatant during storage
• Procoagulant and proinflammatory activities
• Risk associated with age of the red blood cells
• Interaction with complement system, white blood cells
and potential mediator for TRALI
• Procoagulant activity via expression of anionic
phospholipid activation of coagulation cascade
• Increasing risk of TVP with older blood and involvement in
ischaemic brain disease
43. - SHOT (Serious Hasard of Transfusion)
http:www.shotuk.org
-Alexander PJ Vlaar, Transfusion-related acute lung injury: a clinical
review. Lancet 2013; 382: 984-94
-Wenche Jy et al., Microparticles in stored red blood cells as
potential mediators of transfusion complication, Transfusion 2011;
51: 886-893
- Aysola A, et al. Blood Transfusion Therapy; 109-135, AABB 2002
References