If a Patient Has a Reaction to a Blood Transfusion Is Likely to Happen Again

Continuing Education Activity

Transfusion reactions are adverse events associated with the transfusion of whole blood or one of its components. They range in severity from minor to life-threatening and tin can occur during a transfusion, termed astute transfusion reactions, or days to weeks later on, termed delayed transfusion reactions. Transfusion reactions may exist difficult to diagnose as they can present with non-specific, often overlapping symptoms. The most common signs and symptoms include fever, chills, urticaria, and itching. Some symptoms may resolve with trivial or no treatment. However, respiratory distress, high fever, hypotension, and hemoglobinuria may bespeak a more than serious reaction. All cases of suspected reactions should prompt immediate discontinuation of the transfusion and notification of the blood banking company and treating clinician. This activity reviews the evaluation and direction of transfusion reactions and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance outcomes for affected patients.

Objectives:

• Explain when a transfusion reaction should exist suspected.

• Explicate what should be washed immediately upon suspicion of a transfusion reaction.

• Describe measures that should be taken to prevent transfusion reactions.

• Explain the importance of improving coordination amidst the interprofessional team to enhance the delivery of treat patients affected by transfusion reactions.

Admission free multiple choice questions on this topic.

Introduction

Transfusion reactions are defined as adverse events associated with the transfusion of whole claret or one of its components. These may range in severity from minor to life-threatening. Reactions can occur during the transfusion (acute transfusion reactions) or days to weeks later (delayed transfusion reactions) and may be immunologic or not-immunologic. A reaction may be difficult to diagnose as information technology tin can present with non-specific, often overlapping symptoms. The most mutual signs and symptoms include fever, chills, urticaria (hives), and itching. Some symptoms resolve with little or no treatment. Nevertheless, respiratory distress, high fever, hypotension (low blood pressure), and red urine (hemoglobinuria) can bespeak a more than serious reaction.

Types of transfusion reactions include the following: acute hemolytic, delayed hemolytic, febrile non-hemolytic, anaphylactic, simple allergic, septic (bacterial contagion), transfusion-related acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO). All suspected reactions should result in immediately stopping the transfusion and notifying the blood depository financial institution and treating clinician.[i][2][3]

Etiology

Immune-mediated transfusion reactions typically occur due to mismatch or incompatibility of the transfused product and the recipient. They include naturally occurring antibodies in the claret recipient (such as anti-A, anti-B which are typically responsible for astute hemolytic transfusion reactions) likewise as antibodies made in response to foreign antigens (alloantibodies). These alloantibodies account for many reactions including balmy allergic, febrile non-hemolytic, acute hemolytic and anaphylactic. Antibodies present in the blood donor can too cause reactions and are thought to be involved in transfusion-associated lung injury (TRALI).[iv][v][6]

Non-immunologic reactions are usually acquired by the physical effects of blood components or the transmission of disease. Bacterial contamination, for example, results in septic transfusion reactions and is caused by bacterial and/or endotoxin contagion of a claret product. This may happen at the time of collection due to inadequate blood donor arm disinfection, the presence of leaner in the donor'south circulation at the time of drove, or due to improper product handling after collection.

Transfusion reactions tin can also occur unrelated to factors intrinsic to the blood. Examples of these include transfusion-associated volume overload (TACO) and hypothermia.

Epidemiology

Transfusion reactions range in frequency from relatively common, (mild allergic and febrile non-hemolytic reactions) to rare (anaphylaxis, astute hemolytic, and sepsis). Fatal adverse events have been reported to occur nigh commonly with TRALI, and long-term or later adverse events are typically the result of illness manual.

The severity and incidence vary depending on the blazon of transfusion reaction, the prevalence of disease in the donor population, and the extent of follow-up intendance the patient receives. Due to advances in donor screening, improved testing, and automated data systems, the risks and fatalities associated with the transfusion of blood products continue to decrease.[7][8]

Pathophysiology

The pathophysiology varies based on the transfusion reaction.[9][x][11]

Acute Transfusion Reactions

• Mild allergic: Attributed to hypersensitivity to a foreign poly peptide in the donor production.

• Anaphylactic: Like to a mild allergic reaction, however resulting in a more severe reaction. Sometimes this can occur in a patient with IgA deficiency who makes alloantibodies against IgA then receives blood products containing IgA.

• Febrile non-hemolytic: Generally thought to be caused by cytokines released from blood donor leukocytes (white blood cells).

• Septic: Caused past bacteria or bacterial byproducts (such as endotoxin) which may contaminate claret.

• Acute hemolytic transfusion reactions: Can effect in intravascular or extravascular hemolysis, depending on the specific etiology (cause). Immune-mediated reactions are oft a result of recipient antibodies present to blood donor antigens. Non-immune reactions are possible, and occur when cerise blood cells are damaged before transfusion (e.g., by estrus or incorrect osmotic conditions).

• Transfusion-associated circulatory overload (TACO): Occurs when the volume of the transfused component causes hypervolemia (volume overload).

• Transfusion-related astute lung injury: Astute lung injury is due to antibodies in the donor production (human leukocyte antigen or man neutrophil antigen) reacting with antigens in the recipient. The recipient'south allowed system responds and causes the release of mediators that lead to pulmonary edema. Possibly contributing to this are clinical atmospheric condition that predispose the patient including infection, recent surgery, or inflammation.

Delayed Transfusion Reactions

• Delayed hemolytic transfusion reaction: Typically caused by an anamnestic response to a foreign antigen that the patient was previously exposed to (generally by prior transfusion or pregnancy).

• Transfusion-associated graft-versus-host disease: Results from engraftment of donor lymphocytes (commonly found in cellular blood products) into an immunocompromised recipient's os marrow. The donor lymphocytes recognize the patient as foreign and react confronting the recipient's body. The patient's immune system is unable to clear the foreign lymphocytes. This is rare simply often fatal.

History and Physical

A thorough understanding of the patient's medical history and land of health is needed before the transfusion is started. Vital signs are monitored and typically recorded at 15-infinitesimal intervals. A small amount of modify in vital signs during transfusion may exist considered "normal."  These changes may include the following: plus or minus 0.five C in temperature, plus or minus 5 respirations per minute, plus or minus 10 beats per minute in heart rate, and plus or minus 20 mm Hg in blood pressure level.  It is of import to annotation that changes greater than these parameters exercise non hateful that there is a transfusion reaction, it suggests that the bedside nurse should exist actress vigilant in monitoring for a reaction. Abnormal responses include hives, itching, fever greater than ane C in a higher place the temperature at the starting time of transfusion, chills, hypotension, and dyspnea.

Evaluation

Diagnosis of astute transfusion reactions begins by recognition of the signs and symptoms by the bedside. Common signs and symptoms and differential diagnosis are listed below.[12][xiii][14]

• Urticaria/Itching

Urticaria (hives) and/or itching can be the presenting sign of a mild allergic reaction, but can also be associated with the onset of a life-threatening anaphylactic reaction. The transfusion should be stopped, and the patient should be carefully monitored for progression of symptoms.

• Fever/Chills

Fever and/or chills are most commonly associated with a febrile, non-hemolytic reaction, nonetheless; they can likewise be the showtime sign of a more serious astute hemolytic reaction, TRALI, or septic transfusion reaction. If the temperature rises 1 C or college from the temperature at the beginning of transfusion, the transfusion should be stopped. Astute hemolytic reaction or bacterial contamination should exist suspected if there is a greater rise in temperature, or more serious symptoms (e.g., rigors).

• Respiratory Distress/Dyspnea

Dyspnea, or shortness of breath, is a concerning sign that tin can often be seen with more severe reactions including anaphylaxis, TRALI, and TACO. It can also be seen by itself without accompanying symptoms.

• Hypotension

Hypotension tin be seen with an acute hemolytic reaction, septic transfusion reactions, anaphylaxis, and TRALI. They have also been reported without the presence of any other associated transfusion reaction.

• Hypothermia

Hypothermia can exist seen with big volume transfusions of refrigerated products. The only intervention needed is warming the patient and/or blood product.

Treatment / Management

When a transfusion reaction is suspected, the transfusion should exist immediately stopped, and the intravenous line should exist kept open using appropriate fluids (normally 0.9% saline). A clerical cheque should exist performed by examining the product purse and confirming the patient's identification. The patient'south vital signs should be monitored and recorded at fifteen-infinitesimal intervals. A post-transfusion claret sample should be drawn and sent to the lab, in improver to sending the bag and tubing if possible. The blood banking concern more often than not completes additional testing and clerical checks to rule out an incompatible transfusion.

Treatment of specific transfusion reactions is most often supportive. For instance, antihistamines (such as diphenhydramine) can be given for a mild allergic reaction, or an antipyretic can be given for a not-hemolytic febrile transfusion reaction.[9][15]

Differential Diagnosis

• Anaphylaxis

• Disseminated intravascular coagulation

• Hemolytic anemia

• Septic stupor

Complications

• Disseminated intravascular coagulation

• Lung injury

• Renal failure

• Hemolysis

• Death

Pearls and Other Issues

Transfusion reactions are influenced by many factors including the type of component being transfused, the storage requirements, and the patient's co-morbid conditions at the time of transfusion. Understanding how to quickly place transfusion reactions and appropriately manage and care for the patient ensures optimal patient care.

Enhancing Healthcare Team Outcomes

Claret transfusions are oft necessary in medicine, and all healthcare workers have to exist familiar with transfusion reactions. Patient on any ward can receive a blood transfusion and similarly all nurses have to know the potential complications and how to manage them. The majority of blood transfusion reactions occur because of a clerical/nursing error. While some reactions tin be severe and lead to death, many transfusion reactions are benign. Anaphylactic reactions from a blood transfusion are very rare simply often issue in a fatality. Other reactions include TRALI which ranges from 1-9% and ofttimes requires intensive pulmonary support to prevent a fatal result. The incidence of bacterial contamination is rare but can occur from both gram-negative and gram-positive organisms. The key to reducing the morbidity is vigilance on the role of the nurse. During the patient medical history, one should ask about prior transfusions and whatever complications. If there is ever whatsoever doubt near the patient'due south blood grouping or the blood type being administered, the laboratory should be asked to reconfirm the status.[xvi][17] (Level V)

Review Questions

Figure

Transfusion Reaction Signs and Symptoms. Kendall Crookston MD PhD Professor, Pathology and Medicine University of New Mexico School of Medicine

Figure

Causes of transfusion reactions. Jolee Suddock, D.O. Pathology Resident, PGY-i University of New Mexico

References

ane.

Sirianni Thou, Perri G, Callum J, Gardner Due south, Berall A, Selby D. A Retrospective Chart Review of Transfusion Practices in the Palliative Care Unit Setting. Am J Hosp Palliat Care. 2019 Mar;36(3):185-190. [PubMed: 30336680]

2.

McClosky ME, Cimino Brown D, Weinstein NM, Chappini N, Taney MT, Marryott K, Callan MB. Prevalence of naturally occurring non-AB blood type incompatibilities in cats and influence of crossmatch on transfusion outcomes. J Vet Intern Med. 2018 November;32(6):1934-1942. [PMC costless article: PMC6271279] [PubMed: 30307648]

three.

Land KJ, Townsend M, Goldman M, Whitaker BI, Perez GE, Wiersum-Osselton JC. International validation of harmonized definitions for complications of claret donations. Transfusion. 2018 Nov;58(11):2589-2595. [PubMed: 30294786]

4.

Aubron C, Aries P, Le Niger C, Sparrow RL, Ozier Y. How clinicians tin minimize transfusion-related adverse events? Transfus Clin Biol. 2018 November;25(4):257-261. [PubMed: 30197000]

five.

Jasinski South, Glasser CL. Catastrophic Delayed Hemolytic Transfusion Reaction in a Patient With Sickle Cell Disease Without Alloantibodies: Case Report and Review of Literature. J Pediatr Hematol Oncol. 2019 Nov;41(viii):624-626. [PubMed: 30179992]

6.

Erony SM, Marshall CE, Gehrie EA, Boyd JS, Ness PM, Tobian AAR, Carroll KC, Blagg L, Shifflett 50, Bloch EM. The epidemiology of bacterial culture-positive and septic transfusion reactions at a large tertiary academic middle: 2009 to 2016. Transfusion. 2018 Aug;58(8):1933-1939. [PubMed: 30153333]

seven.

Py JY, Cabezon B, Sapey T, Jutant T. Unacknowledged adverse transfusion reactions: Are they a mine to dig? Transfus Clin Biol. 2018 Feb;25(ane):63-72. [PubMed: 28690037]

8.

Jacquot C, Delaney Thousand. Efforts Toward Elimination of Infectious Agents in Blood Products. J Intensive Care Med. 2018 Oct;33(10):543-550. [PubMed: 29562814]

nine.

Siddon AJ, Kenney BC, Hendrickson JE, Tormey CA. Delayed haemolytic and serologic transfusion reactions: pathophysiology, treatment and prevention. Curr Opin Hematol. 2018 November;25(6):459-467. [PubMed: 30124474]

10.

Tariket S, Sut C, Hamzeh-Cognasse H, Laradi Due south, Garraud O, Cognasse F. Platelet and TRALI: From blood component to organism. Transfus Clin Biol. 2018 Sep;25(3):204-209. [PubMed: 29631963]

eleven.

Scher CS. Trauma and transfusion in the geriatric patient. Curr Opin Anaesthesiol. 2018 Apr;31(two):238-242. [PubMed: 29389749]

12.

Garraud O, Cognasse F, Laradi South, Hamzeh-Cognasse H, Peyrard T, Tissot JD, Fontana S. How to mitigate the chance of inducing transfusion-associated adverse reactions. Transfus Clin Biol. 2018 Nov;25(iv):262-268. [PubMed: 30139570]

thirteen.

Fasano RM, Meyer EK, Branscomb J, White MS, Gibson RW, Eckman JR. Impact of Scarlet Claret Cell Antigen Matching on Alloimmunization and Transfusion Complications in Patients with Sickle Cell Disease: A Systematic Review. Transfus Med Rev. 2019 Jan;33(i):12-23. [PubMed: 30122266]

14.

Strasser E. [The new hemotherapy guideline]. Unfallchirurg. 2018 May;121(5):423-428. [PubMed: 29654513]

fifteen.

Long B, Koyfman A. Emergency Medicine Evaluation and Management of Anemia. Emerg Med Clin North Am. 2018 Aug;36(3):609-630. [PubMed: 30037447]

xvi.

Carman M, Uhlenbrock JS, McClintock SM. CE: A Review of Current Exercise in Transfusion Therapy. Am J Nurs. 2018 May;118(v):36-44. [PubMed: 29664740]

17.

DeLisle J. Is This a Blood Transfusion Reaction? Don't Hesitate; Check Information technology Out. J Infus Nurs. 2018 Jan/February;41(1):43-51. [PubMed: 29293197]

romanfamenceromed.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/books/NBK482202/

Share this post