blood transfusion ppt
-
Upload
rodelagapito -
Category
Documents
-
view
334 -
download
39
description
Transcript of blood transfusion ppt
Medicine: 41 items Pedaitric: 55
Anemia: 8 itemsBleeding: 8 itemsMalignancy: 8 itemsPolycythemia: 2 ItemsHypercoagulable: 6 itemsBlood transfusion 6 itemsStem Cell: 3 items
Anemia: 12 itemsBleeding: 12 itemsMalignancy: 12 itemsPolycythemia: 3 itemsHypercoagulable : 4 itemsBlood transfusion: 7 itemsStem Cell: 3 items
Public Health 6 items
BLOOD TRANSFUSION BLOOD TRANSFUSION AND TRANSFUSION AND TRANSFUSION REACTIONREACTION
BLOOD SELECTIONBLOOD SELECTION
Blood GroupsBlood Groups
Phenotype(blood Type)
Genotype
Antibodies present in the blood serum
AIA IA
OrIA I
Anti B
BIB IB
OrIB I
Anti A
AB IA IB -
O ii Anti A and B
Blood GroupsBlood Groups
Rh group Rh antigen Rh antibody
Rh positive None
Rh negative Anti- D
Selection of BloodSelection of BloodRed cell transfusion
◦There must be ABO and Rh D compatibility between the donor’s red cells and the recipient’s plasma. Group A individuals can receive blood
from Group A and O donors Group B individuals can receive blood
from Group B and O donors
World Health Organization: Blood Transfusion Safety
Selection of BloodSelection of BloodRed cell transfusion
◦There must be ABO and Rh D compatibility between the donor’s red cells and the recipient’s plasma. Group O individuals can receive blood
from Group O donors only Group AB individuals can receive blood
from Group AB donors, and also from Group A, B and O donors
World Health Organization: Blood Transfusion Safety
Selection of BloodSelection of BloodPlasma and Components
containing Plasma◦In plasma transfusion, group AB
plasma can be given to a patient of any ABO group because it contains neither anti-A nor anti-B antibody Group AB plasma (no antibodies) can be
given to any ABO group patients Group O plasma (anti-A + anti-B) can be
given to Group O patients only
World Health Organization: Blood Transfusion Safety
Selection of BloodSelection of BloodPlasma and Components containing
Plasma◦In plasma transfusion, group AB
plasma can be given to a patient of any ABO group because it contains neither anti-A nor anti-B antibody Group A plasma (anti-B) can be given to
Group O and A patients Group B plasma (anti-A) can be given to
Group O and B patients
World Health Organization: Blood Transfusion Safety
BLOOD BLOOD TRANSFUSIONTRANSFUSION
Blood Transfusion Blood Transfusion PracticePracticeTHE DECISION to transfuse, like
any other therapeutic decision, should be
based on the risks, benefits, and
alternatives oftreatment.
PRINCIPLES OF CLINICAL PRINCIPLES OF CLINICAL TRANSFUSION PRACTICETRANSFUSION PRACTICE Transfusion is only one part of
the patient’s management. Prescribing should be based
on national guidelines on the clinical use of blood, taking individual patient needs into account.
Blood loss should be minimized to reduce the patient’s need for transfusion.
The patient with acute blood loss should receive effective resuscitation (intravenous replacement fluids, oxygen, etc.) while the need for transfusion is being assessed
Transfusion should be prescribed only when the benefits to the patient are likely to outweigh the risks.
PRINCIPLES OF CLINICAL PRINCIPLES OF CLINICAL TRANSFUSION PRACTICETRANSFUSION PRACTICE The patient’s haemoglobin
value, although important, should not be the sole deciding factor in starting transfusion. This decision should be supported by the need to relieve clinical signs and symptoms and prevent significant morbidity or mortality
The clinician should be aware of the risks of transfusion-transmissible infections in the blood products that are available for the individual patient.
The clinician should record the reason for transfusion clearly.
Blood Products Blood Products (Definition of Terms)(Definition of Terms)Blood product
Whole blood
Any therapeutic substance prepared from human blood
Unseparated blood collected into an approved container containing an anticoagulant-preservative solution
Blood Products Blood Products (Definition of Terms)(Definition of Terms)Blood
component A constituent of blood,
separated from whole blood, such as: ◦ Red cell concentrate◦ Red cell suspension◦ Plasma◦ Platelet concentrates
Plasma or platelets collected by apheresis
Cryoprecipitate, prepared from fresh frozen plasma: rich in Factor VIII and fibrinogen
Blood Products Blood Products (Definition of Terms)(Definition of Terms)Plasma
derivativeHuman plasma proteins
prepared under pharmaceutical manufacturing conditions, such as:◦ Albumin◦ Coagulation factor
concentrates◦ Immunoglobulins
RED CELL RED CELL TRANSFUSIONTRANSFUSION
WHOLE BLOODWHOLE BLOOD(450 ml whole blood donation (450 ml whole blood donation contains:)contains:)Description Up to 510 ml total volume
(volume may vary in accordance with local policies)◦ 450 ml donor blood◦ 63 ml anticoagulant-
preservative solution Hgb approximately: 12 g/ml Haematocrit: 35%–45% No functional platelets No labile coagulation factors
(V and VIII)
WHOLE BLOODWHOLE BLOOD(450 ml whole blood donation (450 ml whole blood donation contains:)contains:) Infection risk Not sterilized, so capable of
transmitting any agent present in cells or plasma which has not been detected by routine screening for transfusion-transmissible infections, including HIV-1 and HIV-2, Hepatitis B and C, other hepatitis viruses, syphilis, malaria and Chagas disease
WHOLE BLOODWHOLE BLOOD(450 ml whole blood donation (450 ml whole blood donation contains:)contains:) Indications
Contraindications
Red cell replacement in Acute Blood Loss with Hypovolaemia
Exchange transfusion Patients needing red cell
transfusions where red cell concentrates or suspensions are not available
Risk of volume overload in patients with:◦ Chronic anaemia◦ Incipient cardiac failure
Ideal component for patients who have sustained acute hemorrhage of 25% total blood volume loss◦Provides both oxygen-carrying
capacity and volume expansion.
WHOLE BLOODWHOLE BLOOD(450 ml whole blood donation (450 ml whole blood donation contains:)contains:)Administratio
nMust be ABO and RhD
compatible with the recipient
Never add medication to a unit of blood
Complete transfusion within 4 hours of commencement
Transfusion should be started within 30 minutes of removal from refrigerator
RED CELL CONCENTRATE RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-(‘Packed red cells’, ‘plasma-reduced blood’)reduced blood’)Description 150–200 ml red cells from
which most of the plasma has been removed
Hgb approximately: 20 g/100 ml (not less than 45 g per unit)
Haematocrit: 55%–75%
RED CELL CONCENTRATE RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-(‘Packed red cells’, ‘plasma-reduced blood’)reduced blood’) Infection risk
Storage
Indications
Administration
Same as whole blood
Same as whole blood
Replacement of red cells in anaemic patients
Use with crystalloid replacement fluids or colloid solution in acute blood loss
Same as whole blood
RED CELL CONCENTRATE RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-(‘Packed red cells’, ‘plasma-reduced blood’)reduced blood’)3 mL PRBC/kg will raise
◦Hb by approximately 1 gm/dl ◦Hct by approximately 3%
In normal sized adult (70 kg) 1 unit PRBC will raise the ◦Hct by 3 - 4% or 1 gm/dl
RED CELL CONCENTRATE RED CELL CONCENTRATE (‘Packed red cells’, ‘plasma-(‘Packed red cells’, ‘plasma-reduced blood’)reduced blood’)Exchange transfusion
◦Term infants -- 80-160ml/kg◦Preterm infants-- 100-200ml/kg
Routine (neonates and children)◦10-20 ml/kgDesired Hct – actual Hct x weight (kg)Desired Hb – actual Hb x weight (kg) x 3
Red Cell TransfusionRed Cell TransfusionIncreases oxygen-carrying capacity
in the anemic patient. Adequate oxygenation can be
maintained with a Hemoglobin content of 70 g/L in the normo-volemic patient without cardiac disease; ◦Co-morbid factors often necessitate
transfusion at a higher threshold
Red Cell TransfusionRed Cell TransfusionThe decision to transfuse should be
guided by the clinical situation and not by an arbitrary laboratory value.
In the critical care setting, ◦Liberal use of transfusions to maintain near-
normal levels of hemoglobin may have unexpected negative effects on survival.
In most patients requiring transfusion◦Levels of hemoglobin of 100 g/L are
sufficient to keep oxygen supply from being critically low.
Red Cell TransfusionRed Cell Transfusion(Pediatric)(Pediatric)Transfusions may be given more
stringently to children because: ◦Normal hemoglobin levels are lower
in healthy children than in adults◦Children do not have the underlying
cardiorespiratory and vascular diseases that develop with aging in adults.
Red Cell TransfusionRed Cell Transfusion(Pediatric)(Pediatric)Children should be better able to
compensate for RBC loss. ◦In the peri-operative period, for
example, it is unnecessary for most children to maintain hemoglobin levels of 80 g/L or greater, a level frequently desired for adults.
Guidelines for Pediatric Red Blood Cell Transfusions
CHILDREN AND ADOLESCENTS INFANTS WITHIN THE FIRST 4 MO OF LIFE
Acute loss of >25% at circulating blood volume
Hemoglobin of <8.0 g/dL in the perioperative period
Hemoglobin of <13.0 g/dL and severe cardiopulmonary disease
Hemoglobin of <8.0 g/dL and symptomatic chronic anemia
Hemoglobin of <8.0 g/dL and marrow failure
Hemoglobin of <13.0 g/dL and severe pulmonary disease
Hemoglobin of <10.0 g/dL and moderate pulmonary disease
Hemoglobin of <13.0 g/dL and severe cardiac disease
Hemoglobin of <10.0 g/dL and major surgery
Hemoglobin of <8.0 g/dL and symptomatic anemia
THE DECISION TO TRANSFUSE THE DECISION TO TRANSFUSE SHOULD NOT BE BASED ON THE SHOULD NOT BE BASED ON THE HAEMOGLOBIN LEVEL ALONE, HAEMOGLOBIN LEVEL ALONE, BUT ALSO ON A CAREFUL BUT ALSO ON A CAREFUL ASSESSMENT OF THE PATIENT’S ASSESSMENT OF THE PATIENT’S CLINICAL CONDITION.CLINICAL CONDITION.
PLATELET PLATELET CONCENTRATESCONCENTRATES
PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsDescription
Unit of issue
Single donor unit in a volume of 50–60 ml of plasma should contain:◦ At least 55 x 109 platelets◦ <1.2 x 109 red cells◦ <0.12 x 109 leucocytes
May be supplied as either:◦ Single donor unit: platelets
prepared from one donation◦ Pooled unit: platelets
prepared from 4 to 6 donor units ‘pooled’ into one pack to contain an adult dose of at least 240 x 109 platelets
PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonations Infection risk
Storage
Same as whole blood, but a normal adult dose involves between 4 and 6 donor exposures
Bacterial contamination affects about 1% of pooled units
Up to 72 hours at 20°C to 24°C (with agitation)
Longer storage increases the risk of bacterial proliferation and septicaemia in the recipient
PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsIndications Treatment of bleeding
due to:◦Thrombocytopenia◦Platelet function
defectsPrevention of bleeding
due to thrombocytopenia, such as in bone marrow failure
Thrombocytopenia is a risk factor for hemorrhage, and platelet transfusion reduces the incidence of bleeding. ◦The threshold for prophylactic platelet
transfusion is 10,000/L. ◦ In patients without fever or infections, a
threshold of 5000/L may be sufficient to prevent spontaneous hemorrhage.
For invasive procedures, 50,000/L platelets is the usual target level.
Guidelines for Pediatric Platelet Transfusions
CHILDREN AND ADOLESCENTS INFANTS WITHIN THE FIRST 4 MO OF LIFE
PLTs < 50 × 109/L and bleeding
PLTs < 50 × 109/L and an invasive procedure
PLTs < 20 × 109/L and marrow failure with hemorrhagic risk factors
PLTs < 10 × 109/L and marrow failure without hemorrhagic risk factors
PLTs at any count, but with PLT dysfunction plus bleeding or an invasive procedure
PLTs < 100 × 109/L and bleeding
PLTs < 50 × 109/L and an invasive procedure
PLTs < 20 × 109/L and clinically stable
PLTs < 100 × 109/L and clinically unstable
PLTs at any count, but with PLT dysfunction plus bleeding or an invasive procedure
PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsContraindicati
ons Not generally indicated for
prophylaxis of bleeding in surgical patients, unless known to have significant pre-operative platelet deficiency
Not indicated in:◦ Idiopathic autoimmune
thrombocytopenic purpura (ITP)◦ Thrombotic thrombocytopenic purpura
(TTP)◦ Untreated disseminated intravascular
coagulation (DIC)◦ Thrombocytopenia associated with
septicaemia, until treatment has commenced or in cases of hypersplenism
PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsDosage 1 unit of platelet
concentrate/10 kg body weight: in a 60 or 70 kg adult, 4–6 single donor units containing at least 240 x 109 platelets should raise the platelet count by 20–40 x 109/L
Increment will be less if there is:◦ Splenomegaly◦ Disseminated intravascular
coagulation◦ Septicaemia
TRANSFUSION OF PLATELET CONCENTRATES
Dose units: Platelet concentrate from 1 donor unit (450 ml) of whole blood contains about 60 x 109/L
Dosage Volume Platelet concentrate•Up to 15 kg 1 platelet conc. 30–50 ml* 60 x 109 /L•15–30 kg 2 platelet conc. 60–100 ml 120 x 109 /L• >30 kg 4 platelet conc. 120–400 ml 240 x 109 /L
* For small infants, the blood bank may remove part of the plasma before transfusion
PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsAdministratio
n After pooling, platelet
concentrates should be infused as soon as possible, generally within 4 hours, because of the risk of bacterial proliferation
Must not be refrigerated before infusion as this reduces platelet function
Should be infused over a period of about 30 minutes
Do not give platelet concentrates prepared from RhD positive donors to an RhD negative female with childbearing potential
PLATELET CONCENTRATES PLATELET CONCENTRATES (prepared from whole blood (prepared from whole blood donationsdonationsComplications Febrile non-haemolytic and
allergic urticarial reactions are not uncommon, especially in patients receiving multiple transfusions
The goal of platelet therapy is to control or stop the bleeding. The clinical response is more important than the platelet count.
PLATELET CONCENTRATES
FRESH FROZEN FRESH FROZEN PLASMAPLASMA
FRESH FROZEN PLASMAFRESH FROZEN PLASMADescription Pack containing the plasma
separated from one whole blood donation within 6 hours of collection and then rapidly frozen to –25°C or colder
Contains normal plasma levels of stable clotting factors, albumin and immunoglobulin fibrinogen, Antithrombin, Proteins C and S. ◦ Factor VIII level at least 70% of
normal fresh plasma level
FRESH FROZEN PLASMAFRESH FROZEN PLASMAUnit of issue
Infection risk
Usual volume of pack is 200–300 ml
Smaller volume packs may be available for children
If untreated, same as whole blood
Very low risk if treated with methylene blue/ultraviolet light inactivation
FRESH FROZEN PLASMAFRESH FROZEN PLASMAStorage At –25°C or colder for up to
1 yearBefore use, should be
thawed in the blood bank in water which is between 30°C to 37°C.
Higher temperatures will destroy clotting factors and proteins
Once thawed, should be stored in a refrigerator at +2°C to +6°C
FRESH FROZEN PLASMAFRESH FROZEN PLASMA Indications Replacement of multiple
coagulation factor deficiencies:◦ Liver disease◦ Warfarin (anticoagulant)
overdose◦ Depletion of coagulation
factors in patients receiving large volume transfusions
Disseminated intravascular coagulation (DIC)
Thrombotic thrombocytopenic purpura (TTP)
Guidelines for Pediatric Plasma Transfusions
INFANTS, CHILDREN AND ADOLESCENTSSevere clotting factor deficiency and
bleeding Severe clotting factor deficiency and
an invasive procedure Emergency reversal of warfarin
effects Dilutional coagulopathy and bleeding
Anticoagulant protein (antithrombin
III, proteins C and S) replacement Plasma exchange replacement fluid
for thrombotic thrombocytopenic purpura
FRESH FROZEN PLASMAFRESH FROZEN PLASMAPrecautions Acute allergic reactions are
not uncommon, especially with rapid infusions
Severe life-threatening anaphylactic reactions occasionally occur
Hypovolaemia alone is not an indication for use
FRESH FROZEN PLASMAFRESH FROZEN PLASMADosage
Administration
Initial dose of 15 ml/kg
Must normally be ABO compatible to avoid risk of haemolysis in recipient
No compatibility testing required
Infuse using a standard blood administration set as soon as possible after thawing
Labile coagulation factors rapidly degrade; use within 6 hours of thawing
CRYOPRECIPITATECRYOPRECIPITATE
CRYOPRECIPITATECRYOPRECIPITATEDescription Prepared from fresh frozen
plasma by collecting the precipitate formed during controlled thawing at +4°C and resuspending it in 10–20 ml plasma
Contains about half of the Factor VIII and fibrinogen in the donated whole blood: e.g. ◦ Factor VIII: 80–100 iu/ pack;◦ Fibrinogen: 150–300 mg/pack
CRYOPRECIPITATECRYOPRECIPITATE Infection risk
Storage
As for plasma, but a normal adult dose involves at least 6 donor exposures
At –25°C or colder for up to 1 year
CRYOPRECIPITATECRYOPRECIPITATE Indications As an alternative to Factor
VIII concentrate in the treatment of inherited deficiencies of:◦ von Willebrand Factor (von
Willebrand’s disease)◦ Factor VIII (haemophilia A)◦ Factor XIII
As a source of fibrinogen in acquired coagulopathies: e.g. disseminated intravascular coagulation (DIC)
CRYOPRECIPITATECRYOPRECIPITATEAdministratio
n If possible, use ABO-
compatible productNo compatibility testing
requiredAfter thawing, infuse as
soon as possible through a standard blood administration set
Must be infused within 6 hours of thawing
CRYOPRECIPITATE-CRYOPRECIPITATE-DEPLETED PLASMADEPLETED PLASMA
CRYOPRECIPITATE-DEPLETED CRYOPRECIPITATE-DEPLETED PLASMAPLASMADescription Plasma from which
approximately half the fibrinogen and Factor VIII has been removed a cryoprecipitate, butwhich contains all the other plasma constituents
Transfusion ReactionsTransfusion Reactions
Immediate effects◦ Hemolytic reactions◦ Febrile reactions◦ Allergic reaction◦ Hyperkalemia◦ Circulatory overload◦ Reactions due to
Contaminated bld
Delayed Effects Hemolytic reaction Alloimmunization Infectious
complications Hemosiderosis
Transfusion ReactionsTransfusion ReactionsManifestations of Adverse
reaction◦Fever with or without chills
most common symptom of Hemolytic transfusion reaction
◦Chills with or with out fever◦Pain at the transfusion site or in the
chest, abdomen or flanks◦Blood pressure changes
Transfusion ReactionsTransfusion ReactionsManifestations of Adverse
reaction◦Blood pressure changes
Acute Hypertension Hypotension Circulatory shock in combination with
fever, severe chills and high-cardiac-output suggest -- Sepsis or HTR
Guidelines for the recognition acute Guidelines for the recognition acute transfusion reactionstransfusion reactions
Signs◦ Localized Cutaneous
reactions Urticaria Rash
Symptoms◦ Pruritus (itching)
Possible Cause◦ Hypersensitivity
(mild)
Category 1: MILD REACTIONS
Guidelines for the recognition of Guidelines for the recognition of acute transfusion reactionsacute transfusion reactions
Signs◦ Flushing◦ Urticaria ◦ Rigors◦ Fever◦ Restlessness◦ tachycardia
Symptoms◦ Anxiety◦ Pruritus◦ Palpatations◦ Mild Dyspnea◦ Headache
Category 2: MODERATELY - SEVERE REACTIONS Possible Cause
Hypersensitivity (mod-severe)
Febrile NHAb to WBCAb to
proteins such as IgA
Contamination with pyrogens and/or bacteria
Guidelines for the recognition of Guidelines for the recognition of acute transfusion reactionsacute transfusion reactions
Signs◦ Rigors◦ Fever◦ Restlessness◦ Tachycardia (rise
of >20% in heart rate
◦ Hypotension (fall of >20% in
systolic BP)◦ Haemoglobuniri
a (red urine)◦ Unexplained
bleeding (DIC)
Symptoms◦ Anxiety◦ Chest pain◦ Pain near infusion
site◦ Respiratory
distress/ shortness of breath
◦ Loin/ back pain◦ Dyspnea◦ Headache
Category 3: LIFE-THREATENING REACTIONS Possible Cause
Acute intravascular haemolysis
Bacterial contamination and septic shock
Fluid overload Anaphylaxis Transfusion
associated acute lung injury
Hemolytic reactionsHemolytic reactions
Non-immune mediated (physical destruction)◦Overheating-use of improvised blood warmers◦Forceful transfusion-pressure cuffs◦Small bore needles(?)◦Using same line for hypotonic solutions or drugs◦Bacterial growth in blood units
Hemolytic reactionsHemolytic reactionsNon-immune mediated (physical
destruction)◦Treatment
Depends upon the severity of reaction Severe reaction, hypotension, shock and
renal dysfunction -- Intensive management
Hemoglobinuria or Hemoglobinemia -- Supportive therapy
Hemolytic reactionsHemolytic reactionsImmune mediated
◦Patient Ab reacting with donor Ag◦Wrong blood given ◦Due to rxn with ABO, Rh, Lewis, Kelly◦Severity depends upon the amount
transfused (as small as 10-15ml)
Hemolytic reactionsHemolytic reactionsImmune mediated
◦The most dramatic and challenging adverse event of blood transfusion.
◦There is rapid destruction of blood cells. Most commonly occurs
Whole blood Packed red cell
Hemolytic reactionsHemolytic reactionsImmune mediated
Can also occur in Fresh frozen plasma Platelet concentrate Other plasma derived
Hemolytic reactionsHemolytic reactionsImmune mediated
◦Acute Hemolytic Transfusion Reaction Immediately after or with in 24 hours of a
transfusion Incidence: 1 in 12000 to 1 in 35000 transfusion Mortality: 1 in 100000 to 1 in 600000 transfusion
Hemolytic reactionsHemolytic reactionsImmune mediated
◦Delayed Hemolytic Transfusion Reaction Recognized 3 to 10 days after
transfusion
Hemolytic reactionsHemolytic reactionsImmune Mediated
Signs and Symptoms of Acute Immune MediatedFeverChills and rigorsAnxiety Feeling of dreadFacial flushingOliguria
DyspneaDiarrheaHypotensionHemoglobinuriaPallorIcterus
Hemolytic reactionsHemolytic reactionsImmune Mediated
Signs and Symptoms of Acute Immune MediatedBack painFlank pain NauseaVomitingChest painAbdominal pain
AnuriaPain on the transfusion siteDiffuse bleedingJaundice
Hemolytic reactionsHemolytic reactionsImmune Mediated
Signs and Symptoms of Chronic Immune MediatedFeverChills and rigorsPallorDiffuse bleeding
Jaundice OliguriaAnuria
Hemolytic reactionsHemolytic reactionsStop TransfusionSeverity depends on amount (as small
as 30ml)Maintain adequate systemic arterial
blood Pressure and tissue perfusion by
hydration Normal saline solution Prevent renal failure (100ml/hr urine
output/use of diuretics)
Hemolytic reactionsHemolytic reactionsVaso-active agents (dopamine)DIC – cryoprecipitate, plateletInvestigate
◦Blood typing◦Coomb’s test
If positive identify antibody responsible◦Urine hemoglobin◦Culture of the remaining blood
Febrile Non-Hemolytic Febrile Non-Hemolytic ReactionReactionDue to anti-leukocyte Antibody
against White cell and platelet of donor
Mild reaction rule out Hemolytic Transfusion
reaction bacterial contamination
Febrile Non-Hemolytic Febrile Non-Hemolytic ReactionReaction43% - 75% of all transfusion
reaction0.5% - 1.4% on non-leukocyte
reduced red blood cell15% recurrence rate
Febrile Non-Hemolytic Febrile Non-Hemolytic ReactionReactionFeverChills with no reason
◦Temperature increase of >1C associated with transfusion and without any other explanation
Febrile Non-Hemolytic Febrile Non-Hemolytic ReactionReactionTreatment
◦Antipyretics/steroids◦Antihistamines not indicated -- not
involve histamine release◦if frequent -- washed Rbc
Allergic Transfusion Allergic Transfusion Reaction Reaction A rare complication of transfusion of
blood components or plasma derivatives
Can occur in (most common):◦ Plasma rich blood component like
Platelet concentrate◦ FFP/Cryoprecipitate
Can also occur:◦ Packed red cells
Allergic Transfusion Allergic Transfusion Reaction Reaction The risk is increased by rapid infusion,
typically when fresh frozen plasma is used as an exchange fluid in therapeutic plasma exchange.
Cytokines in the plasma may be one cause of bronchoconstriction and vasoconstriction in occasional recipients.
Allergic Transfusion Allergic Transfusion Reaction Reaction Allergic transfusion reaction
◦ Due to binding of soluble substance in donor plasma with IgE antibodies release of histamine
Allergic Transfusion Allergic Transfusion Reaction Reaction Uncomplicated allergic transfusion
reaction ◦ 45% of all transfusion Reaction
Anaphylactoid reaction ◦ 1%-3% of transfusion
Anaphylaxis ◦ 0.002%-0.005% per transfused
product
Allergic Transfusion Allergic Transfusion Reaction Reaction Allergic transfusion reaction
◦ Urticaria (diffuse or local) ◦ Discontinue temporarily but need
not be stopped◦ Stopped if with other systemic
manifestation such as hypotension, GI manifestation
◦ Anti histamines
Allergic Transfusion Allergic Transfusion Reaction Reaction Anaphylactoid
reaction ◦ Mild form of:
Fever Chills Nausea Vomiting Diarrhea And/or
Urticaria
Anaphylaxis◦ Severe form (life
threatening◦ Fever◦ Chills◦ Nausea◦ Vomiting◦ Diarrhea ◦ And/or Urticaria
Allergic Transfusion Allergic Transfusion Reaction Reaction Anaphylaxis (life threatening) May include several systems
◦ Respiratory (cough, wheezing, chest tightness)
◦ GI (vomiting, diarrheas, nausea)◦ Circulatory (arrhythmias)
Ig A deficiency
Allergic Transfusion Allergic Transfusion Reaction Reaction Treatment
◦ Stop transfusion◦ Depends upon severity
Hypotension fluids, epinephrine Bronchospasm B2 agonist,
Theophyline
Post transfusion purpura Post transfusion purpura Thrombocytopenia 5 to 21 days Patient makes an alloantibody in
response to platelet antigens in the transfused blood that for a period of time (7-48days) causes destruction of autologous antigen-negative platelets.
Sign/Symptoms: Thrombocytopenia that is frequently profound, purpura, or bleeding
Post transfusion purpura Post transfusion purpura Treatment
◦ Platelet transfusion is of very little value - should be reserved for patients with active bleeding.
◦ Therapeutic plasma exchange may be beneficial.
Transfusion related Acute Transfusion related Acute Lung Injury Lung Injury Rare Mortality: 10% Abrupt onset of non cardiogenic
pulmonary edema◦Rapid failure of pulmonary function usually presents within 1 to 4 hours of starting transfusion, with diffuse opacity on the chest X-ray.
Transfusion related Acute Transfusion related Acute Lung Injury Lung Injury Presence of antibodies in the
donor plasma reactive to recipient leukocyte antigens
Production of inflammatory mediators during storage of cellular blood components
Transfusion related Acute Transfusion related Acute Lung Injury Lung Injury Symptoms
◦ Respiratory distress◦ Fever◦ Chills◦ Increased respiratory rate◦ Cough◦ Tachycardia
Transfusion related Acute Transfusion related Acute Lung Injury Lung Injury Most resolve within 72 hours Treatment
◦ Support (O2, ventilation) ◦ Severe cases may require assisted
ventilation with high FIO2.
Circulatory overload Circulatory overload Fluid overload can result in heart
failure and pulmonary edema.May occur when:
◦ Too much fluid is transfused◦ The transfusion is too rapid ◦ Renal function is impaired.
Fluid overload is particularly likely to happen in patients with:◦ Chronic severe anaemia◦ Underlying cardiovascular disease.
Circulatory overload Circulatory overload May complicate up to 1 in 100
transfusion Symptoms
◦ Dyspnea◦ Orthopnea◦ Cough◦ Tachycardia◦ Hypertension
Infectious Infectious Bacterial /Viral
◦Can occur in: Packed red cells Plasma rich blood component (most
common)Platelet concentrateFFP/Cryoprecipitate
Bacterial InfectionsBacterial InfectionsPacked red cells
◦2.6 per 100000 transfusions Symptoms
Temperature higher than 38.5RigorsHypotensionNausea Vomiting
Dyspnea DiarrheaShockOliguriaDIC
Bacterial InfectionsBacterial InfectionsPlatelet concentrate (common)8-80 per 100000 units transfused
(random) Symptoms
◦Symptoms may begin during or shortly after transfusion or begin up to 2 weeks after transfusion: Fever, Chills, Hypotension
Viral InfectionsViral Infections Hepatitis
◦ Hepatitis A Rare 1:1million
◦ Hepatitis B 1:63000
◦ Hepatitis C◦ Hepatitis D
Viral InfectionsViral Infections Human Herpes Infection
◦ CMV◦ EBV