LABORATORY INVESTIGATION OF

TRANSFUSION REACTION CASES

HS221/5B

Lecturer name: madam evana kamarudin

Date of submission: 25th october 2013

LEARNING OUTCOMESAt the end of this lesson, student will be able to- Define transfusion reaction- Describe initial measures after

transfusion reaction occur- List the preliminary test of

transfusion reaction investigation and its reasons

- Understand additional test for the investigation

INTRODUCTIONTransfusion reaction - Reaction of the body to a

transfusion of blood that is not compatible with its own blood

- An adverse reaction can range from fever and hives, to renal failure, shock and death

ROLE OF CURRENT DAY LABORATORY

Return all transfused packs to Blood Bank full or empty

Return giving set and attached solutionsReturn post transfusion blood samples (opposite arm)Return transfusion sheet with full details 

of suspected reaction

WHAT HAPPEN WHEN TRANSFUSION REACTION GONE WRONG?!!

Retrieved from : http://www.youtube.com/watch?v=qwu8aqzhgq0

INITIAL MEASURE BEFORE THE INVESTIGATION TEST.

The reaction should be documented in the patient’s chart

The unit and all tubing should be returned to the blood bank, along with post-infusion blood and urine samples as clinically indicated

A responsible physician will need to evaluate the patient and determine appropriate clinical care

The patient should then be assessed and supported as necessary while the patient’s physician and the transfusion service are notified

An intravenous line with normal saline should be maintained

Stop the transfusion

SAMPLE CRITERIA

MINIMUM SAMPLE REQUIREMENT

• Verify the patient’s identity using at least two unique identifiers.

• Date and time of sample collection

• Ensure all sections in the form are completed in a legible and detailed manner.

• Complete all information in the “Specimen Collection” section.

• Ensure both the Nursing and Facility of Blood bank clerical checks have been completed and this is documented on the form. This will prevent delays in testing.

SAMPLE REJECTION

• Specimen receives unlabeled/improperly labelled or overlabelled with more than one name.

• Key identifier information is missing, incorrect or discrepant on the sample and/ or requisition

• Specimens not received in the laboratory within 8 hours of collection

• Unacceptable tube received• Specimens which are hemolyzed.

Hemolyzed specimen may contain enough soluble material to interfere with typing reaction, detection of clinically significant antibodies or compatibility testing by acting to neutralize antibodies.

• Insufficient of sample. Generally, a minimum of 6 mL of whole blood yielding at least 3 mL of serum required to provide adequate specimen volume for antibody and compatibility testing.

• Check for clerical errors• Check for visual

hemolysis• Test the post-

transfusion sample: Redo ABO grouping and perform direct antiglobulin test (DAT)

Acute HTR Delayed HTRImmediate procedures

• compare the positive post-transfusion DAT to pre-transfusion DAT

• Post antibody screen to identify antibody, elution of DAT (+) cells

• Re-do pre antibody screening.

The role of lab for hemolytic transfusion

reaction(HTR)

TRANSFUSION REACTION LABORATORY INVESTIGATION

After the initial measure , the 3 basic preliminary test

Purpose : to determine the likelihood the occurrence of hemolytic transfusion reaction.

If there is evidence of hemolysis or if the clinical situation suggests something severe and unusual, the additional test such as TRALI and TACO must be performed.

Clerical check

Visual check

Serology check

CLERICAL CHECK To identify any possibilities of ABO

incompatibility. Compare the component bag, label,

paperwork with patient sample and look for errors.

If an error is found, the physician must be notified.

Most common errors: Misidentification of patient when pre-

transfusion sample drawn. Mix up of samples in the lab. Not enough incubation time.

VISUAL CHECK What’s checked:

Plasma or serum post-reaction & compare with pre-transfusion

This step is done to examine the presence of hemolysis The destruction of red cells and releasing the free

hemoglobin will resulting a pink to red supernatant The pink or red colored serum indicate intravascular

hemolysis Thus the ABO testing must be repeated on the

post-transfusion specimen An urine examination of a post-reaction helps in diagnosis of

an acute hemolysis. The free hemoglobin in the urine indicates the intravascular

hemolysis.

Some causes of false-positive visible plasma hemoglobin:

Poor phlebotomy technique (traumatic stick, drawing through IV line)

Non-immune hemolysis (infusion with 0.45 NS, faulty blood warmers)

Autoimmune hemolysis G6PD deficiency and hemoglobinopathiesSome causes of false-negative visible

plasma hemoglobin: Delay in drawing sample (with functioning

kidneys, hemoglobin may be cleared in several hours)

Sample collected from IV line (dilution of blood)

SEROLOGY CHECK On post-transfusion sample redo the

ABO test and perform the direct antiglobulin test (DAT)

The sample post-transfusion must be preserved in a EDTA preservative (lavender top tube)

If the DAT is positive on the post-transfusion sample, then one should be performed on the pre-transfusion sample.

If the result for pre-transfusion DAT is negative but the result for post-transfusion is positive, it indicates the presence of incompatible red cells.

LAB INVESTIGATION

TRANSFUSION REACTION

PRELIMINARY LABORATORY

SEROLOGYCLERICALVISUAL CHECK

IF ANY OF THESE THREE TEST ABOVE HAVE POSITIVE AND SUSPICIOUS RESULTS, REDO TEST DONE BEFORE BLOOD

TRANSFUSION WHICH ARE:

1. ABO & RHESUS GROUPING (PRE & POST SAMPLE).2. ANTIBODY SCREENING (PRE & POST SAMPLE).3. REPEAT CROSSMATCH (PRE & POST SAMPLE).

1. REDO ABO & RHESUS GROUPING ABO and Rhesus grouping are the most important

serological test performed on pre-transfusion. A full ABO and Rhesus group comprises a forward and

reverse group which must be done at the same time crucial for result’s confirmation.

Below are table of differences between forward and reverse grouping:FORWARD GROUPING DIFFERENCES REVERSE GROUPING

Blood (RBC) USE WHAT Serum/ Plasma

Antigen A, Antigen B. DETECT WHAT Anti-A, Anti-b

Known Anti-A, Anti-B, Anti- AB.

REAGENT USED Known A Cells, B Cells, O Cells.

More Accurate (Method Of Choice)

RELIABILITY Accurate, But Need To Confirm With Forward

Grouping.

Yes NEONATE (UNDER MONTHS AGE)

No ( ABO Antibodies Is Not Detectable)

Below are the table summarize the results for forward and reverse grouping for 4 major ABO blood group.

The principle of ABO grouping is based on a specific agglutination reaction between antigens on RBCs and antibodies in the typing serum.

+ sign indicate agglutination. 0 sign indicate no agglutination.

ABO group

ABO antisera (Forward)

ABO cells (Reverse) Rh D antiser

aAnti-

AAnti-

BAnti-AB

A cells

B cells O cells

Anti-D

A + 0 + 0 + 0B 0 + + + 0 0

AB + + + 0 0 0O 0 0 0 + + +

2) ANTIBODY SCREENING (IAT) The aim of antibody screening is to determine presence of the

unexpected antibody other than anti-A and anti-B. PRINCIPLE

Antibody screening test involve testing patient’s serum against screening cells which are commercially prepared group O red cells suspension.

The cells are selected so that the following antigens are present on at least one of the cell sample; D, C, E, c, e, M N, S, s, P, Lea, Leb, K, k, Fya, Fyb, and Jkb.

These are possible reasons why unexpected antibody present in post reaction sample:

a) Clerical or technical error.b) Passive transfer of antibody from a recently transfused

component.c) Amnestic response : Appearance of alloantibodies can

occurs within hours of exposure (Delayed Hemolytic Transfusion Reaction).

Antibody screening involve three phases to allow for antibody-antigen agglutination:

1) Immediate spin (Room Temperature)

• 3 tubes is used using recipient serum plus saline suspension screening cell I, screening cell II, and the recipient’s own cells for auto control.

• Centrifuge these three tubes and observe for agglutination.

• This phase detects IgM antibodies which usually considered “nuisance” antibodies.

2) 37°C incubation

• This phase required to detect the presence of IgG which is warm-acting antibodies.

• Enhancement media is added such as Low Ionic Strength Solution (LISS) or albumin.

• LISS will speeds up antigen-antibody reaction but unfortunately enhances “nuisance” antibodies, so it is add after immediate spin step.

• Albumin will lower zeta potential so that cells can agglutinate without Coombs step and may detect Rh antibodies.

3) Coombs phase Antihuman Globulin

(AHG)

• This step is important to detect IgG antibodies, which are considered clinically significant and capable of causing HFDN and HTR.

• Wash the cells for 3-4 times after 37C incubation

• Remove saline and add AHG

• Mix and centrifuge• Read the agglutination• If the result is negative, add Coombs Control Cells to confirm negative reactions.

LIMITATION OF ANTIBODY SCREENING TEST

This test cannot detect all antibodies of potential clinical significance

Antibody may be reactive with low incidence antigen absent on screen cells

If antibody is exhibiting “dosage” it may be missed. Duffy (Fy), Kidd (Jk) and Rh antibodies may only be detected with homozygous cells. It will influence decision to use 2 or 3 cell screen

If antibody screening is positive, additional tests to specifically identify antibody using the antibody identification panel and red cell antigen typing must be performed.

3) REPEAT COMPATIBILITY TESTING

The compatibility testing or cross-match procedure is done again for confirmation to determine whether blood donor is compatible with recipient blood.

This test involve 3 phases which are Immediate spin, 37°C, and AHG.

The 2 main function of the repeating cross-match test are: It is the final check of ABO compatibility between donor and

patient. It may detect the presence of an Ab in the patient’s serum

that was not detected in the Ab screening because the corresponding Ag was lacking from the screening cell.

There are two types of crossmatch :Major cross-match• The major cross-match involves

testing the patient’s serum with donor cells.

• To determine whether the patient has an antibody which may cause HTR or decreased cell survival of donor cells.

Minor Cross-match• This test involves testing the

patient’s cells with donor plasma.

• To determine whether there is an antibody in the donor’s plasma directed against an antigen on the patient’s cells.

THE CROSS-MATCH HAS MANY LIMITATIONS. A COMPATIBLE CROSS-MATCH DURING PRETRANSFUSION WILL NOT:

Guarantee normal survival of transfused RBCs Prevent immunization of the recipient Detect all unexpected RBC antibodies in the

recipient serum Prevent delayed hemolysis due to an amnestic

antibody response to antigens against which the patient has previous but undetectable immunization

Detect all ABO grouping errors either in donor or recipient

Detect most group D grouping errors in the donor or recipient

1. TRALI2. TACO3. Acute hemolytic transfusion

reaction4. Allergic transfusion

reaction(Anaphylactic)5. Bacterial contamination6. Delayed hemolytic transfusion

reaction7. Transfusion associated GVHD8. Post- transfusion purpura9. Transfusion-induced

hemosiderosis

ADDITIONAL TEST NEEDED FOR DETERMINATION OF:

TRALI & TACO CASES

Retrieved from : http://www.youtube.com/watch?v=_oQVMcGUwIE

1. TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI)

Defnition: Adverse reaction to transfusion that is characterize by hypotension and

pulmonary edema.

Cause: Occur when human leucocyte antigen (HLA) or human neutrophil antigen (HNA) antibodies

found in the donor’s plasma are directed against the recipient’s leucocyte antigen. It is likely to occur to those who were transfused with a large volume of plasma such as

fresh frozen plasma (FFP).

Symptoms: Acute onset of fever, chills, dyspnoea, tachypnoea, tachycardia, hypotension, hypoxaemia

and noncardiogenic bilateral pulmonary oedema leading to respiratory failure during or within 6 hours of transfusion.

TACO is frequently confused with TRALI as a key feature of both is pulmonary oedema and it is possible for these complications to occur concurrently.

The main constant feature in TRALI is hypotension.

LAB INVESTIGATION Chest X-ray Chest X-ray showed massive

pulmonary congestion with diffuse infiltrates for TRALI patient.

A is the normal chest x- ray image while C is the subsequent radiographic imaging of the chest showed massive pulmonary congestion with diffuse fluffy infiltrates

Human leukocyte antigens (HLA) andhuman neutrophil alloantigen (HNA)antibody detection• HNA-3a, the former 5b, HLA class

I and HLA class II antibody indicate severe and fatal cases

• For HLA antibody screening, antibody binding tests (EIA, immunofluorescence) are preferred- 20% of blood components contain HLA alloantibodies

• HNA antibodies are usually detected by immunofluorescence. However, HNA-3a antibodies which are known to cause severe TRALI reactions are often better detected by agglutination

2. TRANSFUSION ASSOCIATED CIRCULATORY OVERLOAD

(TACO)Definition: Adverse reaction to transfusion that is

characterize by hypertension and pulmonary edema.

Cause: This is usually due to rapid or massive

transfusion of blood in patients with diminished cardiac reserve or chronic anaemia.

Patients over 60 years of age, infants and severely anaemic patients are particularly susceptible

Symptom: Dyspnoea, orthopnea, cyanosis,

tachycardia, hypertension and pulmonary oedema (may develop within 1 to 2 hours of transfusion)

Lab investigation:

B-natriuretic peptide (BNP) test• It is a 32-amino-acid

polypeptide secreted from the cardiac ventricles in response to ventricular volume expansion and pressure overload.

• BNP levels were measured by use of fluorescent immunoassay.

• In TACO patient, BNP level shows raised.

• Normal value for BNP

0-99 nanograms per liter

3. ACUTE HEMOLYTIC TRANSFUSION REACTION

Definiton: immunologic destruction of transfused red

cells, due to incompatibility of antigen on transfused cells with antibody in the recipient circulation.

Tends to present immediately or within 24 hours after transfusion

Causes: common cause is transfusion of ABO/Rh

incompatible blood due to clerical errors,

presence of red cell alloantibodies (non-ABO)

in the patient’s plasma which have not been

previously identified.

Symptom and clinical finding: Fever, chills, chest pain or hypotension. Transfused patients develop oliguria,

haemoglobinuria and haemoglobinaemia.

Lab investigation: Diagnosis is confirmed by measuring

urinary Hb, bilirubin, and haptoglobin. Intravascular hemolysis produces free

Hb in the plasma and urine; haptoglobin levels are very low. Hyperbilirubinemia may follow.N.R Blood Urine

Hb Male: 13.8 to 17.2 gm/dL

Female: 12.1 to 15.1 gm/dL

negative

Bilirubin 0.3 to 1.9 mg/dL

-

haptoglobin 41 - 165 mg/dL

-

Table 1 :Normal range

4. ALLERGIC TRANSFUSION REACTIONS (ANAPHYLACTIC)

Definition:• Anaphylaxis is a life-threatening allergic reaction that can occur after only a

few milliliters of blood have been transfused

Cause: In the case of patients with IgA deficiency, the presence of IgA in the donor's

plasma will trigger for anaphylaxis to occur. Because they lack IgA, their immune systems develops anti-IgA and sensitize to IgA.

Symptom: Commonly range from one lesion to widespread urticarial lesions but may be

associated with mild upper respiratory symptoms, nausea, vomiting, abdominal cramps or diarrohea.

LAB INVESTIGATION Serum IgA Double immunodiffusion assay

may be used as a screening test to identify individuals with an IgA level below 2 to 4 mg/dL.

A more sensitive ELISA method with a sensitivity of 0.02 mg/dL is then necessary to determine which individuals are truly IgA deficient.

Truly deficient individuals, with levels below 0.05 mg/dL, may develop anti-IgA antibodies.

Mast cell tryptase test• The tryptase test is a useful

indicator of mast cell activation. It may be ordered to confirm a diagnosis of anaphylaxis 

• With anaphylaxis, tryptase levels typically peak about 1 to 2 hours after symptoms begin.

• The reference range of serum tryptase is less than 11.4 µg/L

BACTERIAL CONTAMINATION

Definition: A small number of bacteria enter the blood

during collection or processing. During storage, bacteria may proliferate and if

possible produce endotoxin which then will be transfused to another person.

It is rare but is more often reported with platelet concentrates (stored at 20-24°C) than with red cells (stored at 1−6°C).

LABORATORY INVESTIGATION

1. Examination of the pack Examine: discolouration, smell and gram stain May rapidly confirm the diagnosis.

2. Blood cultures Blood cultures from different IV site- to detect any colonies formed on the

streaked agar plate.

3. Product cultures (include a gram stain) Gram positive bacteria : - Staphylococcus epidermidis, Staphylococcus aureus, Bacillus cereus, Group

B streptococci Gram negative bacteria: - E. coli, Pseudomonas species and other gram-negative organisms.

DELAYED HEMOLYTIC TRANSFUSION

REACTIONDefinition: A type of transfusion reaction that can occur 1 to 4 weeks after the transfusion. As a result of a secondary immune response with a drop in hemoglobin level. Usually less severe than acute hemolytic transfusion reaction.

Symptoms: Patients may present with unexplained fever and anaemia usually 2 to 14 days after

transfusion of a red cell component. The patient may also have jaundice, high bilirubin, high LDH, reticulocytosis,

spherocytosis, positive antibody screen and a positive Direct Antiglobulin Test (DAT).

Cause: After transfusion, transplantation or pregnancy, a patient may make an antibody to a

red cell antigen that they lack. If the patient is later exposed to a red cell transfusion which expresses this antigen a DHTR may occur.

DHTRs may also occur with transfusion transmitted malaria and babesiosis.

LABORATORY INVESTIGATION

Component Delayed HTR result Normal value

Lactate dehydrogenase (LDH) Elevated -

Bilirubin Elevated 0.3 to 1.9 mg/dL

Serum haptoglobin Low 41 - 165 mg/dL

Free hemoglobin in urine Present in urine -

D-dimer Elevated (may be) -

Prothrombin test (PT), Elevated (may be) 12-14 s

Partial thromboplastin time (PTT)

Elevated (may be) 18-28 s

* D-dimer, prothrombin test (PT), and partial thromboplastin time (PTT) may be elevated, particularly with disseminated intravascular coagulation (DIC).

TRANSFUSION ASSOCIATED GRAFT VERSUS HOST DISEASE (GVHD)

Definition: A serious complication due to the engulfment and proliferation of

donor T-lymphocytes against patient. Usually caused by transfusion of un-irradiated blood to an

immunocompromised recipients.

Symptoms: Patients present with fever, rash and diarrhoea commencing 1-2

weeks post-transfusion.

Causes: Viable T lymphocytes in the transfused component engraft in the

recipient and react against tissue antigens in the recipient.

LABORATORY INVESTIGATION

Skin biopsy

Acute GVHD of the skin is characterized by varying degrees of damage to the epidermal keratinocytes.

Degrees of damage:

Grade 1

- Vacuolization of the basal keratinocytes is present.

Grade 2

- Both basal keratinocyte vacuolization and dyskeratotic keratinocytes are present.

Grade 3

- Focal clefting of the basal layer is formed.

Grade 4

- The epidermis is totally separated from the underlying dermis.

Human Leucocyte Antigen (HLA) typing

White cells from a blood sample are a convenient source of “ tissue ” that the laboratory can use to determine individual’s HLA type.

Matching of stem cell donor to a recipient is determined by comparing their tissue types which can be present on nearly all tissues in the body.

Sample requirements:

- 20-30ml of blood sample and white cells are isolated from whole blood .

Two methods used:

1. Serological testing: white cells are used.

2. DNA testing: where DNA extracted from white cells is used.

HLA typing reported as A 3,32, B 7,37, DR 1,15 which will compare the result of recipient and donor stem cell

http://www.transfusionmedicine.ca/articles/iga-deficiency

POST-TRANSFUSION PURPURA

LABORATORY INVESTIGATION

Platelet antibodies screening Method: Flow cytometry Serum samples are tested against

isolated group O donor platelets typed for following antigens:

( HPA-1a/b, -2a/b, -3a/b, -4a, -5a/b)

Antibody binding to donor platelets is detected using fluorescent-labeled polyclonal antibodies specific for human IgG and IgM

Positive result means platelet-reactive antibodies detected

Definition: Adverse reaction to blood or platelet

transfusion that occurs when the body produces alloantibodies.

This antibody is directed against human platelet antigen system.

Symptoms: Thrombocytopenia (platelet counts <10 x

109/L in 80% of cases), typically 7 to 10 days after a blood

transfusion. Bleeding from mucous membranes and the

gastrointestinal and urinary tracts is common.

Causes: The immune specificity is against a

platelet-specific antigen yet both autologous and allogeneic platelets are destroyed. 

TRANSFUSION-INDUCED

HEMOSIDEROSISDefinition: Iron overload in the liver, heart, pancreas, and endocrine glands in the thalassemic

patients Hemosiderosis that occur due to blood transfusion may occur after transfusion of as few

as 100 units of blood which each unit contain 250mg of iron.

Symptoms: Early symptoms are often vague such as muscle weakness, fatigue and weight loss.

Later skin pigmentation, arthropathy, diabetes, cardiac failure and hepatic dysfunction can occur.

Evidence of iron overload with organ dysfunction, may occur after transfusion of 50 to 100 red cell units.

Causes: Each unit of red cells contains about 250 mg of iron and the average rate of iron

excretion is only about 1 mg/day. Hence in chronically transfused patients, the majority of iron can’t be excreted quickly

enough and iron accumulates in the reticuloendothelial system, liver, heart, spleen and endocrine organs

LABORATORY INVESTIGATION

1. Serum iron/ ferritin This is a blood test that may be done on a regular basis for high risk

individuals. Serum ferritin levels increase as the amount of non-transferrin bound iron

(NTBI) increases in the blood. Blood ferritin levels that are greater than 1,000 mcg/L indicate iron overload. Healthy men usually have a serum ferritin of 12-300 mcg/L and healthy

women 12-150mcg/L.

2. Liver biopsy Liver biopsy to check iron concentration. While this test may give slightly more accurate results than serum ferritin

levels, it requires a fairly invasive procedure that can lead to complications, such as infection and bleeding.

If the biopsy shows greater than 7 mg iron per gram of liver, the patient is considered iron overloaded.

WE HAD EXPLAINED ABOUT ALL GENERAL LAB INVESTIGATION WHEN

THERE IS PRESENCE OF TRANSFUSION REACTION..SO NOW,,LETS TEST YOUR UNDERSTANDING BY EXPLORING THIS

EXAMPLE OF CASE STUDY BELOW TOGETHER!!

Example of case study :

Transfusion relate acute lung injury

(TRALI)

CASE STUDY A 25 year old female suffered a broken femur in a car accident,

underwent surgery the next day and received 2 units of packed red blood cells.

Patient was extubated after adequate spontaneous ventilation was established. Approximately 3 hours after transfusion and 15 minutes after extubation,

-patient’s respiratory rate increased from 12 to 32breaths/minute.

-temperature rose from 36.7 to 38.7 C. -blood pressure dropped from 120/70 to 101/74. -Blood oxygen saturation (Spo2) dropped from 100% to 90%. -chest x-ray showed severe pulmonary edema. -Patient’s arterial blood gas (ABG) showed hypoxemia With PaO2

of 60 mmHG. -Patient’s oxygen saturation was not maintained above 90%

with O2 supplementation and patient was reintubated.

LAB DIAGNOSIS RESULTS

A differential diagnosis of pulmonary/fat embolism, aspiration pneumonitis, pulmonary edema, fluid overload, ARDS and TRALI were suspected.

Chest X-ray showed massive pulmonary congestion with diffuse infiltrates. Urine sample showed hemolysis.

ETT suction showed blood stained secretions. Supportive measures were taken in the ICU and

patient showed improvement clinically. By Post-operative day two, chest x-ray became

clear and patient was weaned and extubated. Laboratory studies at the blood transfusion service

confirmed the diagnosis of TRALI at a later date.

TRALI DIAGNOSIS AND MANAGEMENT

DISCUSSION

There are two distinct mechanisms have been suggested to have caused TRALI which are:-

1) An antibody-mediated reaction between recipient granulocytes and anti-granulocyte antibodies from donors who were sensitized during pregnancy.

2) An antibody-mediated reaction between recipient granulocytes and anti-granulocyte antibodies from donors who were sensitized during previous transfusion.

TRALI is caused most often when anti-HLA class I and anti-neutrophil antibodies from blood products are passively transfused to a recipient.

Less frequent is the recipient antibody reacting to the white blood cells in the transfused blood product.

The subsequent antibody-antigen reaction in the recipient activates complement, and C5a produced during complement activation promotes neutrophil aggregation, margination, and sequestration in pulmonary microvasculature.

The entry of neutrophils into the lung damages and increases permeability of the pulmonary microvasculature, leading to pulmonary edema. This reaction is likely to occur in multiparous women.

Another theory suggest accumulation of lipid product resulting from cell degradation. This pro-inflammatory molecules accumulate during storage of cellular blood products.

Early diagnosis of TRALI is important in the supportive treatment measures of these reactions and should be suspected with symptoms that may include:- Dypsnea Hypoxemia hypotension fever along with physical findings of bilateral

pulmonary edema, even many hours after the actual transfusions.

Suspicion of TRALI should be reported to the blood transfusion service so appropriate action can be taken to prevent future morbidity and mortality in other patients

TREATMENT Treatment of TRALI is largely supportive, and

oxygen supplementation is needed in almost all cases. Intubations and mechanical ventilation might be necessary for severe hypoxemia.

Prevention Donors who have been implicated in TRALI

should be permanently deferred or subsequent donations should be limited to the production of frozen-deglycerolized or washed red blood cells.Multiparous donors should be prospectively identified and their blood should be screened for HLA and neutrophil antibodies or diverted for uses other than whole blood, fresh frozen plasma or single-donor apheresis platelets.

OVERALL SUMMARY REGARDING TRANSFUSION REACTION LAB

INVESTIGATION,,

Retrieved from: http://www.youtube.com/watch?v=frYwXcLv5yc

REFERENCES

http://www.transfusionmedicine.ca/articles/iga-deficiency

http://www.patient.co.uk/doctor/blood-transfusion-reactions

http://labtestsonline.org/understanding/analytes/tryptase/tab/test

http://www.transfusion.com.au/adverse_transfusion_reactions/