BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing...

48
BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015

Transcript of BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing...

Page 1: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

BLOODTRANSFUSION

BRI BUDLOVSKY R3

JANUARY 2015

Page 2: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

OVERVIEW

• The process

• Blood components

• Testing

• Consent

• Transfusion reactions

Page 3: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

DONATION

Page 4: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

DONATION

TEST SPECIFIC AGENTS TESTS

GroupABO,Rh

AlloantibodiesABO and Rh antigen testing

Virus

HIVHep BHep CHTLV

West Nile

Antibodies, nucleic acid testing

BacteriaSyphilis

Bacterial contaminationSerology

Bacterial Culture (plt only)

ParasitesChagas in

at risk donorsantibody

Page 5: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

BLOOD COMPONENTS

Page 6: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

CONSENT: HISTORY

Page 7: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

CONSENT

• Time to think of alternatives

• Describe the product

• Describe benefits & risks

• Describe alternatives

• Answer questions/confirm understanding

• Complete consent form

• Document in chart

Page 8: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

RISKS• Hep B: 1/ 153,000

• Hep C: 1/ 2.3 million

• HIV: 1/ 7.8 million

• Minor urticaria: 1/100

• Febrile non-hemolytic: 1/300

• ABO incomp/serious immune: 1/ 40,000

• Sepsis: 1/ 10,000 plts, 1/ 500,000 pRBCs

Page 9: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

TESTING

TESTTIMIN

G(min)

Group 5 Patient tested for ABO and Rh antigen

Screen 45Patient tested for alloantibodies from prior

transfusion/pregnancy

Xmatch 45Incubate patient’s blood with donor blood, checks for

immune reaction due to alloantibodies

Computer Xmatch

2Computer picks appropriate unit based on patient and

donor testing. Blood is not actually mixed.

DAT45

RBCs from patient are washed, and then mixed with Coombs Reagent. If they stick together, it means they

have antibodies on their surface (+ for immune transfusion reaction)

Page 10: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

TRANSFUSION REACTIONS

Page 11: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

56F – POD#3

• L hemi-colectomy for diverticulitis

• Transfusion for low Hb

• You are called for FEVER

Page 12: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

DDX: FEVER

• Usual post-op fever causes

• Transfusion specific:

• Febrile non-hemolytic• Hemolytic• Septic

Page 13: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

FEBRILE TRANSFUSION REACTION

During or within 4 hours of transfusion:

• >38°C

• Increase by 1°C

Page 14: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

MANAGEMENT

• STOP THE TRANSFUSION

• Maintain IV access

• Check patient ID and blood product

• Notify the blood bank

Page 15: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

RED FLAGS

• T>39°C• Hypotension/shock• Tachycardia• Dyspnea• Back/chest pain• Oliguria/Hematuria• Nausea/vomiting• Bleeding from IV sites

Page 16: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

NON-HEMOLYTIC

Page 17: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

HEMOLYTIC BACTERIAL CONTAMINATION

Page 18: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

BACTERIAL CONTAMINATION

• From:

• Donor skin/blood• Poor handling

• 10% of transfusion mortality

Page 19: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

BACTERIAL CONTAMINATION

• Cultures

• Two patient sites• Bag/line lab

• Antibiotics

• Pip-tazo• Vanco

Page 20: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

HEMOLYTIC REACTION

• ABO incompatibility

• ½ from proper labeling wrong patient• Others from improper labeling, testing

error etc.• Non-ABO incompatibility

• From pregnancy/previous transfusion

• >50%: No morbidity• <10%: Fatal

Page 21: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

MANAGEMENT

• Check labels

• Call blood bank

• UA for Hb

• DAT

• Fluids

• Supportive

Page 22: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

60F – VAGINAL BLEEDING

• Transfused 2U pRBC

• You are called for:

• SOB• SaO2

Page 23: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

DDX: DYSPNEA

• Usual post-op SOB causes

• Transfusion specific:

• TACO• TRALI• Anaphylaxis

Page 24: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

TACO

• Fluid overload

• Impaired cardiac function +/-• Fast rate of transfusion

• 1/700 transfusions

• Management

• Stop transfusion• Oxygen• Diurese

Page 25: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

TACO

• Prevention is key

• Identify at risk patients• Diuretics between/after units• Slow speed (4 hours/U)• Divide products into smaller aliquotes

• Reduce speed without waste

Page 26: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

TRALI

• Acute onset:

• Hypoxemia

• Bilateral lung infiltrates on CXR

• No cardiac cause

• No ALI before transfusion, and now ALI present

• DURING or WITHIN 6 hours of transfusion

• No other risk factors for ALI

ALI

Page 27: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.
Page 28: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

TRALI

• Etiology

• Passive transfer of antibodies• Neutrophil reaction to biologically active

compounds in blood• Most common cause of transfusion

related death (up to 10% of TRALI)

• Usually 1-2 hours post (up to 6)

Page 29: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

TRALI - MANAGEMENT

• Supportive care

• No evidence for steroids or diuretics

• Reducing risk:

• No plasma/plasma products from multip females• Platelets from males or nullip females• Pool platelets in male plasma• Testing of & deferral of donors with TRALI hx• 2/3 reduction

Page 30: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

ANAPHYLAXIS

• Mechanism unclear

• Transfusing IgA / IgE• Antibodies to serum proteins• Transfusion an allergen consumed by donor

• Rare

• 1/40,000• 3% of transfusion fatalities

Page 31: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

URTICARIA

• 1/100 transfusions

• Management:

• Interrupt transfusion• Benadryl 25-50mg IV• Resume if:

• Urticaria improving/mild• No associated symptoms

Page 32: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

72M – DIALYSIS PATIENT

• Transfused 2U pRBC for chronic support

• Complaining of palpitations

Page 33: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.
Page 34: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

HYPERKALEMIA

• Prolonged storage & irradiation K leakage

Page 35: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

62F – LGIB

• 6U pRBC for massive LGIB in ER

• C/O:

• Anxiety• Foot and hand “cramping”• Peri-oral tingling

Page 36: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

CITRATE TOXICITY

• Rare!

• Massive transfusion or plex only

• Replace PO or IV

• More common:

• Metabolic alkalosis

Page 37: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

SUMMARY

• Know the risks

• Know the benefits

• Know the alternatives

• Document

• Have a high suspicion

• Stop the transfusion and investigate

Page 38: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

TO STOP OR NOT?

• Sick or severe

• TRALI

• Hemolysis

• Lab/clerical error

• Sepsis

• Anaphylaxis

• Urticaria

• Febrile non-hemolytic

• TACO

Page 39: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

• Fever• NHTR• Sepsis• HTR

• Dyspnea• TRALI• TACO• Anaphylaxis

• Allergic• Urticaria• Anaphylaxis

• Hypotension• Sepsis• Anaphylaxis• HTR

Page 40: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

REFERENCES• Bloody Easy

• Rosen’s

• Up-to-date

• CMPA

• www.hemophilia.ca

• TRALI: A clinical review. The Lancet. Sept 2013. Vlaar et al.

Page 41: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

EXTRA SLIDES

Page 42: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.

STORAGE

Page 43: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.
Page 44: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.
Page 45: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.
Page 46: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.
Page 47: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.
Page 48: BLOOD TRANSFUSION BRI BUDLOVSKY R3 JANUARY 2015. OVERVIEW The process Blood components Testing Consent Transfusion reactions.