Q4ii / 20A03 / 17A16: Consequences of blood transfusion
20A03: Exam Report
Outline the potential adverse consequences of blood transfusion.
43% of candidates passed this question.
As only an outline was asked for, a brief statement about each complication was sufficient.
Better answers were structured using a classification of: Acute Immunological, Acute Non- 2 Immunological, Delayed Immunological and Delayed Non-immunological. Examples of expected detail would include the following:
E.g. Bacterial infection – a statement outlining the incidence of bacterial infection, a common causative organism or why bacterial infections are more commonly associated with platelet transfusions than red cells would have scored the marks allocated to ‘bacterial infection’.
E.g. Acute Haemolytic Transfusion Reaction – a statement about red cells being destroyed due to incompatibility of antigen on transfused cells with antibody of the recipient and an approximate incidence scored the marks allocated to AHTR.
An excellent resource is the Australian Red Cross transfusion website as listed in the suggested reading section of the syllabus.
17A16: Exam Report
List the potential problems resulting from blood transfusion and methods used to minimize them.
53% of candidates passed this question.
This question required a broad answer. It was generally well answered. Those candidates who scored well had a good structure to their answers e.g. grouping potential electrolyte disturbances together, and infectious risks together etc. and including methods used to
minimise these risks in appropriate detail.
Q4ii / 20A03 / 17A16: Outline the formation, structure & function of the platelet
Definition: Transfusion Reaction is an adverse consequence of transfusion of blood products
Early recognition by careful monitoring of vital signs is integral to Mx of Blood Transfusions Reactions
Early
Reaction
Immediate Hemolytic
Pathology
ABO incompatibility
Ab in recipient blood attacks Ag on RBC
↓
Massive hemolysis & cytokine release
↓
Hct, haemoglobinuria, Fever, circulatory collapse
Acute <24h
Treatment
Stop transfusion
IV access
Commence resuscitation
Check compatibility
Reaction
Delayed Hemolytic
Pathology
Delayed >24h
Treatment
Reaction
Fevers (non-hemolytic)
Pathology
Donor leukocyte Ag’s reacting to Ab in recipient plasma
Release of endogenous pyrogens
Treatment
Check compatibility
Reduce rate of transfusion
Paracetamol
Samples for LDH, haptoglobins,
Reaction
Allergic Reactions
Uritcaria
Hives
Pathology
IgE reaction to foreign proteins in plasma
Treatment
Stop transfusion
Antihistamines
If settle, restart transfusion
If symptoms recur discard blood unit
Reaction
TRALI
Pathology
ARDS < 6hrs transfusion
Immune TRALI (Ab mediated)
- Leukocyte Ab in plasma of donor blood directed against Human Leukocyte Ag (HLA) and Human Neutrophil Ag (HNA) of recipient
- Release of lipids from RBC of donor which trigger
Non Immune TRALI
Treatment
ICU, mechanical ventilation
Reaction
Bacterial Infection
Pathology
RBC storage 4C
Yersinia enterocolitica and Pseudomonas more likely
Treatment
Culture patient & blood, Tx appropriately
Inspect & report bag
Reaction
Circulatory Overload
Pathology
TACO (Transfusion Associated Circulatory Overload)
APO < 6hrs transfusion
Treatment
Stop transfusion
O2 + Diuretics
Reaction
Air Embolism
Pathology
Venous gas embolism from external environment will cause R H failure and circulatory collapse
Treatment
Identify and disable entry of gas
100% FiO2
Aspirate CVC if in situ
Hyperbaric therapy
Reaction
Thrombophlebitis
Pathology
Infected IV access
Treatment
Remove IV access
Screen for DVT if suspected
Late
Reaction
Infection
Viral/Bac/Parasite
Pathology
Blood product storage
Treatment
Pre-transfusion qns & screening of donated blood decreased the incidence of this
Still a possibility – Tx appropriately
Reaction
Graft vs Host Disease
Pathology
Donor T cells mount immune response against host tissue
Destruction of BM by donor T LC causes lymphopenia
Treatment
Universal leukodepletion
Irradiation of blood products to inactivate donor LC
90% cases fatal
Reaction
Iron Overload
Pathology
Chronic transfusions
Treatment
Iron chelating agents
Reaction
Immune Sensitization
(Rh D Antigen)
Pathology
Rh (-) mother exposed to infant Rh (+) blood
Develops antibodies against those antigens
Treatment
Anti-D IgG treatment
Massive Transfusion
Definition: The replacement of a patient’s total blood volume <24h
***Massive Transfusion is an independent risk factor for development of MOF
All complications of blood transfusion plus:
Reaction
Hyperkalaemia
Pathology
K increases during storage as Na/K/ATPase pumps fail. Rare
Treatment
Caclium gluconate, Insulin, dextrose
Reaction
Acid Base Abnormalities
Pathology
Citrate toxicity of anticoagulant and lactic acid build up during storage
Treatment
Requires tissue perfusion, liver metabolism
Ensure adequate fluid resuscitation
Calcium (citrate chelates Ca++)
Reaction
Hypothermia
Pathology
RBC stored 4C
Each unit drops patient temp 1C
L shift ODC
Treatment
Active warming of patient and environment
Reaction
Clotting Abnormalities
Pathology
Haemorrhage can precipitate DIC and consumption of platelets and coag factors
Multiple RBC
Treatment
Aggressive, expectant replacement of clotting factors
Local Massive Transfusion Protocol
Liase w Haematologist
Avoid hypothermia, active warming
Avoid excess crystalloid
- Author: Krisoula Zahariou