2. Adverse Reactions
Transfusion reactions are untoward
events which could be mild to life
threatening
Majority uneventful
10% of transfusion recipients may
suffer from untoward effects
3. Types of Transfusion Reactions
Immune reactions
Non immune reactions
Immediate
During or within few hours of
transfusion
Delayed
Days or weeks after the transfusion
4. Immune Transfusion
Reactions
Due to :
Patient Abs against donor Ags or
vice versa
Red cells
White cells
Platelets
Reaction to plasma proteins
7. Hemolytic Transfusion Reactions
Increased destruction of donor red cells
Acute - Intravascular hemolysis
ABO incompatibility – due to activation of
complement cascade
Delayed - Extravascular hemolysis
Rh/minor grp.incompatible - IgG/C3d coated
cells removed in RES
8. Causes for acute hemolysis
Red cell incompatibility – ABO incompatibility
Accidental heating or freezing of RBC
Red cells in contact with water or 5% Dextrose
Bacterial contamination
Administering red cells through small gauge
needle
9. ABO incompatible Transfusion Reactions
Mainly due to misidentification of the
patient
Most occur in emergencies, in ICU, OTs
In unconscious & anaesthetized
patients
10. ABO Incompatibility
Causes
– Clerical errors – commonest cause
Misidentification of pt / recipient
Wrong samples / blood packs
– Technical errors
In Grouping of pt. / donor blood
In crossmatching
12. INVESTIGATIONS IN HTR
Samples
1. Pre- transfusion samples – stored upto 7
days
2. Post-transfusion blood sample
3. Post-transfusion urine sample
4. Blood bag with infusion set used
13. TRANSFUSION REACTION WORK UP
Clerical
Check records
Pre transfusion
Post transfusion
Compatibility report
Check labels
Blood bag
Blood samples
14. TRANSFUSION REACTION WORK UP
Serological investigations
Repeat blood grouping / cross
matching
Pre transfusion
Post transfusion
Donor
Perform DAT
Perform antibody screening
15. TRANSFUSION REACTION WORK UP
Biochemistry
Serum Bilirubin
Urine – Hemoglobin / blood
Microbiology
Blood culture at 4o C, 22o C & 37o C from blood bag,
tubing and recipient’s blood for bacteria & fungi
16. Management of AHTR (Acute HTR)
Stop transfusion immediately
Maintain an I.V. line
Provide cardio respiratory support
Ensure diuresis
Maintain BP, HR and airway
Collect first urine sample for haemoglobinurea
Check the patient’s identification and the blood
pack
17. Management of AHTR….
Report the reaction immediately to BTS
Record
Type of reaction
Length of time
Volume, type & unit number
Send post transfusion sample of blood & remaining
blood pack with filled reaction form to the BB
Check any other pt. receiving blood transfusion
18. Delayed Hemolytic Transfusion Reaction
(DHTR)
Days or weeks after the blood transfusion
Due to secondary immune response
Rh or minor blood group Abs
Extra vascular hemolysis
19. LABORATORY FEATURES –
DELAYED HTR
Fall in haemoglobin
Appearance of new allo antibody
Spherocytosis
Positive DAT
Antibody detected in eluate
20. Clinical Features of DHTR
Gradual red cell destruction
Occurs 5-10 days after transfusion
Jaundice appear 5-7 days after transfusion
Fall in Hb level
Prevention
- screening for alloAbs
- selection of appropriate red cells
21. Non-hemolytic Febrile Transfusion
Reactions (NHFTR)
Definition
Temperature increase of 1oC, rigors & tachycardia
in the absence of any other demonstrable cause
Clinical manifestations
Fever /chills
Nausea /vomiting
Hypotension / shock
Management
Slowing of the infusion
Antipyretic
Leucocyte poor red cells
22. Non Hemolytic Febrile Transfusion
Reactions (NHFTR)
Due to
– Abs in recipient against Ags of donor
platelets or WBC
o HLA Ags
o Granulocyte specific Ags
o Platelet specific Ags
– Presence of cytokines in blood components
More common in multi-transfused pts
23. Allergic / Anaphylactic
Reactions
Mainly due to plasma proteins
Severity is variable
o Mild – urticaria
o Severe – anaphylactoid
o Due to IgA deficiency
o Occurs within minutes of commencing
transfusion
Common in pts with repeated plasma component
therapy
24. Clinical Features
Mild – urticaria to Severe - Anaphylactoid
Cough
Respiratory distress
Bronchospasm
Nausea, vomiting, diarrhea
Circulatory collapse
Hypotension & shock
25. IgA Deficiency
Commonest isolated immunodeficiency
Incidence is 1 : 1000
Anti IgA – reacting with transfused IgA
Anaphylactic reaction
Dramatic reaction with few ml. of blood or
plasma
Can result in death unless managed promptly
26. Management
Mild – slow down rate & antihistamine
Severe - Stop the transfusion
Adrenaline – 0.5ml IM (1 : 1000), Antihistamine,
Steroids
Treat hypotension
Prevention
Transfuse at slow rate
Use Washed blood
Blood from IgA deficient donor
Autologous blood transfusion
27. ADVERSE EFFECTS OF
CONTAMINATING LEUCOCYTES
HLAAlloimmunisation
Platelet Refractoriness
Graft Rejection
Viral Transmission
CMV EBV
HTLV-I HTLV-II
Immune Suppression
Post operative infections Reactions
Cancer Recurrence
NHFTR GVHD
Contaminating
Leucocytes
28. Transfusion Related Acute
Lung Injury (TRALI)
1:5,000 - 1:190,000
WBC antibodies in donor (occasionally in recipient)
Respiratory failure
hypotension
bilateral pulmonary edema
WBC Ab screen in donor/recipient
WBC Xmatch, Chest X-ray
Supportive care until recovery
29. Chest X-Ray in TRALI
Bilateral pulmonary infiltrates
in hilar region
31. Rarely reported but almost always fatal
More common in immunosuppressed patients
In normal patients : first degree relatives
HLA similarity between donor and recipient
allows proliferation of donor lymphocytes
More common with
- restricted genetic pool eg. Japan
- fresh blood
TA-GVHD
33. Post-transfusion purpura (PTP)
Recipient platelet Ab (anti-HPA-1a,1b,3a and 5b)
destroy transfused as well as autologous platelets
More in multiparous women
S/s: Thrombocytopenic purpura/ bleeding, 8-10d post-
Tx
Diagnosis: Platelet antibody screen and identification
Treatment: IV Ig, HPA-1 -ve platelets, Plasmapheresis
36. PREVENTION OF CIRCULATORY
OVERLOAD
Use packed cells
Use small aliquots at a
time
Transfuse at slow rate
Prop up the patient
Keep patient warm
Use diuretics
37. IRON OVERLOAD
Excess iron deposits in tissues
- organ failure, esp. heart and liver
Management
Iron chelation – S. ferritin < 2000
ug/L
Desferrioxamine
38. Bacterial contamination
I Infections caused by cryophylic bacteria:
Pseudomonas aeruginosa, E.coli, Klebsiella
II Infections caused by bacteria that grow at Room
temperature (Contamination of blood and blood
products)
Staphlyococcus epidermidis and aureus, Serratia
III Bacteria that rarely cause blood borne infections
Yersinia, Salmonella, Campylobacter
Rapid bacterial detection technologies
40. PREVENTION OF BACTERIAL
CONTAMINATION
Cleaning and sanitation – GMP
Aseptic cleaning before phlebotomy
Use sharp needle to avoid skin entering
blood
Use of bags with sampling pouch
Use of heat sealer for sealing the tubing
Storage temperature
Do not enter bag before use /use
segments
Microbiological QC
41. PREVENTION OF TRANSFUSION
TRANSMISSIBLE INFECTIONS
Repeat regular voluntary donations
Donor screening – Questionnaire /private
interview
Testing of donated blood
Autologous blood
Inactivation of virus/pathogen in blood products
Judicious use of blood
Alternatives to hemotherapy
42. RECORDS OF TRANSFUSION
REACTIONS
Records of all reactions
Results of investigations
Consequences and mortality
Maintained for 5 years
At the end of the year evaluated by hospital
transfusion committee (HTC)
Steps to prevent these reactions
43. Precautions to Avoid Transfusion
Reactions
Avoidance of clerical errors
Proper identification of pt.
Correctly labeled samples
Proper identification of the recipient and
the blood pack
Careful & close observation of the pt.
while transfusion
Avoid unnecessary blood transfusion
44. Transfusion of Blood ???
Therapeutic Benefits of
blood Tx
o Improve O2 carrying capacity
o Ensure hemostasis
o Enhance resistance against
infection
Risks in blood Tx
o Immunological risk
o Infection risk
o Procedural risk
Prescribe only when the benefits clearly overweigh risks
