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ooTransfusion ReactionSHRADDHA

BANSAL.C.

M.SC PART II

MICROBIOLOGY

BIOSCIENCE DEPT



CONTENTS:

Blood transfusion Indications of blood transfusion

History

Blood transfusion reaction

Hemolytic blood transfusion reaction Non hemolytic blood transfusion reaction

and its types.

Graft versus host disease

General considerations to prevent blood transfusion reaction. References



BLOOD TRANSFUSION

Blood transfusion is the

infusion of whole blood or a

blood component such asplasma, red blood cells or

platelets into the patients

venous circulation.



.INDICATIONS OF BLOOD

TRANSFUSION To increase oxygen carrying capacity of

blood. e.g. Anemia.

To compensate for the blood loss. e.g.

severe hemorrhage, hemolytic

anemia, surgical operations.

To restore blood volume. e.g. Burns, shock.

To promote haemostasis.e.g hemophilia.



HISTORY The first historical attempt at blood

transfusion was described by the 17th

century chronicler Stefano Infessura.

Infessura relates that, in 1492, Pope

Innocent VIII sank into a coma, the

blood of three boys was infused into

him at the suggestion of a physician.

T

he boys were ten years old,however, not only did the pope die,

but so did the three children.



Many patients had died until

1901,Karl Landsteiner

explained the mechanism

that mixing of blood from two

individuals can lead to blood

clumping or agglutination.

The clumped red cells can

crack and cause toxic

reactions, which can have

fatal consequences.



It is the abnormal signs and

symptoms that will occur

during or after transfusion and

effects the patients health.

The severity of the reaction

varies from being relativelymild to more severe which at

times can be fatal.

BLOOD TRANSFUSION

REACTION



TYPES OF BLOOD

TRANSFUSION REACTION There are two types of blood transfusion

reactions:

1. Hemolytic transfusion reaction.

2. Non hemolytic transfusion reaction.



HEMOL YTIC TRANSFUSION

REACTIONS

Hemolytic transfusion reactions are themost severe type of reactions that occurswhen the red blood cell were given to thepatient are destroyed by the patient¶s ownimmune system & it can be categorized

into two types:(a) Intravascular transfusion reaction

(b) Extravascular transfusion reaction



INTRAVASCULAR

TRANSFUSION REACTION In ITR, haemolysis of red cells takes place within the

circulatory system. This type of reaction is mainly due to

IgM antibodies, mediated by the rapid activation of

complement system and is usually associated with the

transfusion of ABO incompatible blood.

The clinical effects of an ITR are immediate, usually

within minutes after starting the transfusion, thus also

called as ACUTE HAEMOL YTIC TRANSFUSION

REACTIONS (AHTR).



EXTRAVASCULAR

TRANSFUSION REACTION These reactions are rarely severe and mainly

due to IgG antibodies. These antibodies bring

about the destruction of red cells by the

macrophages in the spleen or liver. The clinical evidence of reaction is some what

slower and in some cases may be delayed upto

two weeks or more after transfusion, thus also

called as DELAYED HEMOL YTIC

TRANSFUSION REACTIONS (DHTR).



CausesClinical

Manifestation Management

Hemolytic

transfusion

reaction

Sensitivity to

plasma

protein or donor

antibody,

which reacts

with

recipient

antigen

Flushing and

fever

itching ,rash urticaria, hives

asthmatic

wheezing

pain in the

back and chest

STOP TRANSFUSION

IMMEDIATEL Y.

KEEP VEIN OPEN WITH NS.

Notify doctor , infection

control, blood bank

Give antihistamine asdirected.

Send blood samples and

blood bags to blood bank.

Collect urine samples for

testing.



Laboratory Investigations:

Pink or red discoloration on post-transfusion

plasma indicates the presence of free

haemoglobin due to red cell destruction.

Yellow or brown discoloration of the sampledrawn 6-8 hour after transfusion indicates

increased bilirubin.

Perform direct antiglobulin test (DAT) on the pre-

and post-transfusion sample.



Continue:

Rapid test to distinguish hematuria fromhemoglobinuria. The onset of red urine during or

shortly after a blood transfusion may represent

hemoglobinuria (indicating an acute hemolytic

reaction) or hematuria (indicating bleeding in thelower urinary tract).



Prevention

ASSESSMENT Before transfusion ask the patient about

past reaction. If patient has history of

reaction, alert health care provider , have

emergency drugs available, and remain atbed side for the first 30min.

The time between the suspicion of

transfusion reaction, investigation and

treatment should be as short as possible.



NON HEMOL YTIC

TRANSFUSION REACTION These are mild type of transfusion reactions and can be

categorized as:

- Febrile non hemolytic transfusion reaction

- Urticarial (allergic) transfusion reaction.- Anaphylatic transfusion reaction.

- Circulatory overload.

- Non cardiogenic pulmonary edema.

- Graft versus host disease.



Febrile non haemolytic

transfusion reaction These reactions are the most common and

account for over 90% of transfusion reaction.

These are benign, self limiting reaction due to

the presence of antibodies to WBC or plateletsantigens and are usually seen in multi

transfused patients.



Causes Clinical

Manifestations

Management

Febrile non

haemolytic

transfusion

reaction

hypersensitivity to

donor white blood

cells , platelets, or plasma protein

-sudden chills

and fever

-anxietyheadache

Malaise

STOP TRANSFUSION

IMMEDIATEL Y

KEEP VEIN

OPEN WITH NS

Notify doctor ,

infection control, blood

bank

give antipyretics asdirected.

check temperature

every 1/2hrs.or as

indicated

send blood samples

and blood bags toblood bank. Collect

urine samples for

testing.



Prevention

- ASSESSMENT

Give antipyretic before

transfusion as directed.

Leukocyte ± poor blood

products may be

recommended for futuretransfusion.



Urticarial (Allergic) transfusion

reaction

This type of reaction may be due to the patients

performed, regains reacting with transfused

allergens or due to soluble substances in donor

plasma.



Causes Clinical

Mainifestations

Management

Urticarial

(allergic)

transfusionreaction

Transfusion of

blood or bloodcomponents

contaminated

with bacteria.

rapid onset of

chillsHigh fever

Vomiting ,

diarrhea

Marked

hypotension

STOP TRANSFUSION

IMMEDIATEL Y

KEEP VEIN OPEN

WITH NS.

give antipyretics as

directed.

check temperature every

1/2hrs.or as indicated obtain cultures of

patients blood

return blood bags &

blood set to blood bank.

treat septicemia as

directed ( IV fluids.Antibiotics...

Give antihistamine.



Prevention

Do not permit blood to stand

at room temperature longer

than necessary warm

temperatures promotebacterial growth.

Inspect blood for gas

bubbles, clotting or abnormalcolor.



Anaphylactic transfusion

reaction

This is a severe, life threatening reaction which

occur in rare patients who are IgA deficient and

have developed anti-IgA antibodies.

The reaction developed quickly within minutes of starting the transfusion.



Causes Clinical

Mainifestations

Management

Anaphylactic

Transfusion

reaction

Fluid

administrated at arate or volume

greater than the

circulatory

system can

accommodate

increased bloodin pulmonary

vessels.

rise in venous

pressure gastrointestinal

upset

Cough

STOP TRANSFUSION

IMMEDIATEL Y

KEEP VEIN OPEN

WITH NS

place patient upright

with feet in dependent

position. administer prescribed

diuretic, oxygen,

epinephrine.



Prevention

Any patient with anti IgA who

had an anaphylactic reaction

should be given:

Plasma free products e.g.

deglycerolized RBCs.

Plasma containing products

from IgA deficient donor only.



Non cardiogenic pulmonary edema

It is rare but potentially fatal transfusion reaction. It is caused by donor¶s leucoagglutinins which

reacts with recipients leucocytes and produceaggregates.

These leucocytes aggregates are trapped in thepulmonary circulation causing endothelialdamage by oxidative, physical and other means.



Clinical

Manifestations

Management Prevention

Non

cardiogenic

pulmonary

edema

acute respiratory

distress

Fever and chillsX-rays shows

pulmonary edema

No other sign of

heart failure

STOP

TRANSFUSION

IMMEDIATEL Y

KEEP VEIN OPEN

WITH NS

- give steroids every

6 hrs for 48 hrs.

-Give respiratorysupport.

Use washed red

blood cell in futuretransfusion.



Causes Clinical

Manifestations

Management

Circulatory

overload

Fluid

administrated at ahigh rate or

volume greater

than the

circulatory system

can accommodate

Increased blood inpulmonary vessels

rise in venous

pressureCough

breathless

STOP TRANSFUSION

IMMEDIATEL Y

KEEP VEIN OPEN

WITH NS

Notify doctor ,

infection control, blood

bank place patient upright

with feet in dependent

position.

administer prescribed

diuretic, oxygen.



Prevention

Concentrated blood products

should be given whenever

positive.

Transfuse at a rate within the

circulatory reserve of the patient.

Monitor central venous pressureof patient with heart disease.



Graft versus host disease

GVHD is a rare complication following transfusion but hasbeen reported in variety of conditions in which the

immune system is depressed.

They are the result of antibodiesin the recipient¶s plasma directed

against antigens on the

donor¶s erythrocytes.



Causes Clinical

Manifestations

Management

Graft

versus host

disease

donorslymphocytes

engrafting in the

recipient &

reacting against

host antigen.

-Fever, rash,

diarrhoea

-Liver dysfunction

-Bonemarrow

suppression

leukocyte free blood or

irradiated bloodcomponents.



GENERAL

CONSIDERATIONSTO PREVENT

BLOODTRANSFUSION

REACTION



LABPRATORY ST AFF

DONORS

BEFORE receiving blood

DURINGInstruct the client

Remain with the patient-15min

V/S ± every hour until 1hr after

transfusionBlood components are infused

within standard time limits ( 4 hours)

AFTER

Healthy donors

Blood screening for infectious

diseases.Blood compatibility ± RH

Proper storage

Antibody screening

Doctor order Consent

Patient assessment

Preparation-IV cannula

Equipment - Multi-lead tubing

Premedicate the PT.30min-T AB.

before transfusion - IV

AFTER receiving bloodCheck blood

Patient identityPatient assessment ± bed side

Close observation to the pt.

Proper dispose of IV tubing/bag

Documentation



Continue«.

Compatibility Test:

MAJOR MINORPatient¶s serum Patient¶s cell

+ +

Donor¶s cell Donor¶s serum



REFERENCES

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