BT Reaction complication and Massive blood transfusion.pptx

blood transfusion and reactions.

1. Blood transfusion reaction. Massive transfusion

2. Type of transfusion reaction Immune mediated Hemolytic TR Immediated Delayed Non- hemolytic TR Immediate delayed Non immune mediated Immediate delayed

3. Type of transfusion reaction

4. Acute immunological Immediate (acute) haemolytic transfusion reaction Febrile nonhemolytic. Minor/major allergic. Anaphylaxis. TRALI. Delayed immunological Delayed haemolytic transfusion reaction. Post transfusion purpura . Transfusion associated graft vs host disease.

5. Acute nonimmunological Bacterial contamination. Transfusion-associated circulatory overload (TACO). Delayed nonimmunological Transfusion transmissible infections (TTIs) (HIV/HBV/HCV). Transfusion-associated circulatory overload (TACO).

6. Acute hemolytic reaction Caused by ABO incompatibility, resulting in immune mediated intravascular hemolysis due to recipient anti-RBC antibody interaction with donor erythrocytes. Occurs less than 24 hours of transfusion. Signs/symptoms of acute hemolytic reaction: Classical Traid : Fever, Flank pain, red/brown urine(hemoglobinuria). (1) Anxiety, fever, chills/rigors, nausea, back and flank pain, hematuria, hypotension, DIC, hemoglobinemia, and acute renal failure. (2) Many symptoms are masked by general anesthesia(fever, flusing of skin, tachycardia, hypotention ) .

7. If you suspect an acute hemolytic reaction: Immediately stop the transfusion . Begin supportive care, which includes the following: (a)should be aggressively hydrated until volume overload is suspected. (b) BP support with pressors and inotropes as needed. (c) Preservation of renal function with fluid administration and diuresis. (d) Alkalinization of urine with sodium bicarbonate and administration of corticosteroids. (e)Extracorporeal membrane oxygenation and Exchange transfusion is the last resort of treatment. 3) Obtain urine and plasma hemoglobin, repeat type and screen, coagulation parameters, blood counts, direct antiglobulin test, LDH, and haptoglobin. 4) Send the blood component being infused to the blood bank with a sample of the patient’s blood to confirm or rule out incompatibility.

8. Delayed hemolytic reaction Caused by extravascular hemolysis of donor erythrocytes. Due to the presence of antibodies in recipient serum developed after previous transfusions or pregnancy at levels too low to be detected during the crossmatch. Signs/symptoms of delayed transfusion reaction (1) More insidious presentation, 24 hours to 30days posttransfusion after a seemingly compatible transfusion. (2) Include anemia, mild fever, increased unconjugated bilirubin, jaundice, hemoglobinuria, decreased haptoglobin, and spherocytosis on the blood smear. 4) Because the hemolysis is extravascular, the reaction is much less severe than in an acute hemolytic reaction, and the symptoms are self-limited.

9. Transfusion related acute lung injury An acute respiratory distress syndrome occurring within 2-6 hours after transfusion. Characterized by noncardiogenic pulmonary edema manifesting as hypoxia and bilateral infiltrates on chest radiograph. Two hit hypothesis : (1)an underlying and prexisting clinical condition that alerts and prepares the lung neutrophils. (2)in transfusion of cellular blood products, which causes the activation of lung neutrophils in the lung compartment causes TRALI. TRALI is the leading cause of death from transfusions. Treatment of TRALI: Supportive care with most patients requiring mechanical ventilation. Small tidal volumes are recommended. Hypotension is generally responsive to IV fluid. Despite the presence of pulmonary edema, diuretic administration can worsen the patient’s condition.

10. TRALI patient showing pulmonary infiltrates

11. Transfusion associated circulatory overload Unlike TRALI, TACO refers to an excessive administration volume of blood leading to pulmonary edema with evidence for increased left-sided cardiac filling pressures (e.g., elevated B-type natriuretic peptide/protein, elevated central venous pressure, new or worse left heart failure). The first hit in TACO is represented by the poor adaptability for volume overload.  The second hit in TACO is reflected by suboptimal fluid management and inappropriate infusion practices (such as rapid infusion rates), which have frequently been related to the onset of TACO. TRALI and TACO have overlapping clinical findings and can be easily confounded . leukoreduction may play a role in the reduced incidence of TACO . Diuretics may be helpful, but in both cases supportive measures such as lung protective ventilation should be instituted. A more restrictive transfusion practice, thus limiting the exposure of a patient to potential volume overload.

12. TACO VS TRALI

13. Allergic and Anaphylactic reaction Allergic reactions can be minor, or anaphylactic. Most allergic transfusion reactions are minor and caused by the presence of foreign protein in the transfused blood. The most common symptom is urticaria associated with itching. Occasionally, the patient has facial swelling. Antihistamines are used to relieve the symptoms of the allergic reaction. Infrequently, a more severe form of allergic reaction involving anaphylaxis occurs in which the patient has dyspnea, hypotension, laryngeal edema, chest pain, and shock. These are anaphylactic reactions caused by the transfusion of IgA to patients who are IgA deficient and have formed anti-IgA. This type of reaction does not involve red cell destruction and occurs very rapidly, usually after the transfusion of only a few milliliters of blood or plasma. Patients who experience anaphylactic reactions should be given transfusions with washed RBCs so that all traces of donor IgA have been removed or with blood that lacks the IgA protein.

14. Transfusion-Associated Graft-Versus-Host Disease TA-(GVHD) is caused by engraftment of donor lymphocytes from transfused blood products, initiating an immune reaction against recipient tissues. TA-(GVHD) is rare and fatal complication, develops 2 to 30 days following transfusion. Occurs when viable donor t-cells in the blood or blood products attack the recipient tissue, where recipient immune system is incapable to destroy. Severely immunocompromised patients are at risk. Also, directed donations from first- or second-degree relatives are at risk because transfused lymphocytes with shared HLA haplotypes cannot be recognized and eliminated. Clinical features : fever, generalized rash, leukopenia, and pancytopenia occur. Sepsis and death usually result. Diagnosis is mainly based on clinical manisfestation and histological study of skin or rectal biopsy. Treatment : emergency stem cell transplantation. Irradiation of blood can prevent transfusion-associated GVHD from occurring.

15. Massive blood transfusion Massive blood transfusion is defined as replacement of 1 circulating blood volume (around 10-12 units of prbc ) within 24 hours. transfusion of 10 units of blood within 6 hours. Transfusion of 4 units of blood within 1 hour with continuous blood loss. Transfusion of 1 unit of blood within 5 minutes.

16. Ultra massive blood transfusion : using of more than 20 units of PRBCS with in 24-48 hours period. Potential indication are : situation resulting in acute blood loss and hemodynamic instability. Cardiac and vascular surgeries , obstetric hemorrhage , trauma, gastrointestinal bleeding.

17. ABC score. Assessment of blood consumption score : is a tool for predicting the necessity of massive transfusion. Pulse rate exceeding 120bpm. Systolic blood pressure below 90mmHg A positive result on the focused assessment with sonography for trauma (FAST) exam Penetrating torso injury. A score of 2 or more points indicate the necessity to initiate an MTP.