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Any unfavorable response by a patient to the infusion of blood or blood products.
Transfusion Reaction
Transfusion reactions can be:
-Hemolytic and non-hemolytic
-Acute and delayed
-Immune mediated and non-immune mediated
-Infectious
Reaction occurs within 24 hours of transfusion, often during transfusion (may include hemolysis)
Acute Transfusion Reactions
Acute HTR symptoms
-Fever (w/ or w/o chills)
-Abdominal, chest, back, or flank pain
-Dark/red urine
-Decreased BP
-Shock
-DIC
-Kidney failure
-Death
If a reaction begins to take place, immediately a nurse will:
-Nurse will stop transfusion
-Keep transfusion line open
-Support the BP of patient and try to keep it up
-Clerical check (bag labels, check patient armband against the bag, ect)
After an AHTR and the unit has been returned to the BB, a med tech will:
-Check all labels again
-Check bag for hemolysis
-Pretransfusion sample is checked for hemolysis and then ABO and DAT are retested
-If all check out, then lab is cleared to send patient a new unit of blood and will discard the old one. (No antigen is coating the RBCs)   
If the test results do not check out after the initial checks and retesting, the lab then:
-Repeat the antibody screen on both samples (pre & post)
-Crossmatch
-ABO/Rh unit to check for correct labeling
DAT checks for antibodies that are:
-Bound in vivo
Prevention for HTR are:
-Careful patinet IDing
-Careful testing of patient samples
-Proper labeling of blood
-Use of new technology (barcodes, ID chips, ect)
Delayed HTR
-Can occur days-months after transfusion (mostly 3-7 days)
-Usually a secondary immune response b/c and antibody's titer has decreased over time and are undetected (not a primary response)
Antibodies associated with Delayed HTR
-Kidd (most prevalent)
-Fy
-K
-M
Delayed HTR prevention:
-Review past transfusion records
-Provide antigen (-) blood 
Non-immune Related Hemolysis is a problem with the unit that is infused due to:
-Improper storage, freezing, and deglyceroliztion process
-Needle size for infusion a unit (too small= hemolysis)
-Rapid infusers and/or squeezing the bag
-Improper use of blood warmers
-Microwaving the blood
-Infusion with IV fluids (hypotonic will hemolyze)
Transfusion-related Sepsis has implicated what organisms?
-Yersinia enterocolitica
-Serratia liquefaciens
-Pseudomonas fluorescens
Symptoms with sepsis:
-Fever of >38.5C of 101F
-shaking chills
-decrease in BP
Sepsis can be fatal to the patient. If this is suspected, we should:
-Immediately stop transfusion
-Culture and gram stain the unit AND the patient
-Provide a broadspectrum antibiotic and supportive care to patient
What are the bacterial characteristics associated with sepsis?
-Cause shock, DIC, and renal failure
-Cold temp lovers are gram negative 
-Warm temp lovers are gram positive and associated with platelets. Generally the staph family and baccillus....    
A one degree rise in temperature associated with transfusion that has no other explanation is:
Febrile Non-Hemolytic Transfusion Reaction
Febrile Non-HTR symptoms are:
-Shaking chills
-Increase in respiration
-Change in BP
-Anxiety
-Can occur 1-2 hours after transfusion
Causes of Febrile Non-HTR are:
-Leukocyte antibodies
-Accumulated cytokines in cellular blood components
-HLA antibodies  
Treatment for Febrile Non-HTR
-DC the unit
-Do the transfusion rxn work up
-Give acetominophen to the patient
-Can be prevented by giving patient acetominophen prior to transfusion   
A recipient's IgE reacting with some component blood can cause:
An allergic reaction. Severe reactions have been seen in patients who lack IgA and have the IgA antibody.
*This is the ONLY transfusion reaction that can continue after the treatment.
TRALI stands for:
Transfusion Related Acute Lung Injury
TRALI symptoms are:
-Fever
-Chills
-Dyspnea
-Cyanosis
-Hypotension
-Pulmonary edema
-Sometimes leukopenia or neutropenia      
The mechanism is TRALI is:
-associated with infusions of antibodies from donor to leukocyte antigens of recipient
-HLA Class I and Class II antigens have been associatd
-Leading cause of transfusion-related fatalities reported to the FDA
Treatment for TRALI is:
respiratory and volume support (Some may require O2 or a ventilator)
TRALI has no mechanism for prevention, so it is suggested that:
-Donors who were implicated in a TRALI reaction are deferred
-Multiparous (multi-pregnancies) females be tested for HLA and HNA antibodies and/or deferred
-Use male donors for plasma donation
TACO stands for:
Transfusion-Associated Circulatory Overload
Symptoms of TACO are:
-Dyspnea
-Orthopnea
-Cyanosis
-Tachycardia
-Jugular venous distension
-Edema
-Headache
-Tightness in the chest
-Dry cough
TACO treatment and prevention:
-Stop the transfusion
-Place patient in a sitting position
-Give the patient oxygen and diuretics
-To prevent, give the blood slowly over 3-4 hours   
TACO and TRALI are commonly confused with each other. What is the biggest difference between them?
-TACO = constant elevated BP
-TRALI = fluxuating BP levels
Treating and preventing an Air Embolism:
-Place patient head down on the left side
-Proper use and inspection of infusion pumps, tubing, and pheresis equipment
-Most common in intra-operative and post-operative situations (cell savers during surgery, ect)
Transfusion associated GVHD
:Typically 8-10 days after transfusion, but can occur 3-30
-Macropapular rash
-Fever
-Enterocolitis with diarrhea
-Elevated liver function tests
-Pancytopenia
-Profound bone marrow aplasia
-90% mortality rate        
For TA-GVHD to occur, what 3 things are required?
1. Differences in HLA antigens between the recipient and donor.
2. Immunocompetant cells must be present in the transfused RBCs.
3. Host must reject the immunocompentant cells.
THERE IS NO TREATMENT.   
Irradiating all cellular products will help prevent ____?
TA-GVHD
Post-Transfusion Purpura is a thrombocytopenia 1-24 days after the transfusion. It is caused by?
Alloantibodies in the recipient exposed to platelet antigens.
-Treated with steroids, plasma pheresis.
-Antigen matching helps prevent this.
- <10,000= low platelet count
Iron overload is:
Toxic build-up of hemosiderin and ferratin as RBCs are destroyed.
*Noted in chronically transfused patients
Iron overload can lead to:
-heart failure
-liver failure
-diabetes
-hypothyroidism
Sepsis is caused most by:
Platelets and skin plug
Massive transfusion is defined as receiving more than ___ units of blood OR replacement of over ___% of the blood volume in 3 hours.
10 units; 50%
Large volumes of plasma-containing components transfused quickly can cause this complication, especially if the recipient has liver disease.
Citrate Toxicity
Citrate levels rising can bind what two things, resulting in what condition?
Calcium and ionized calcium binding, which can lead to hypocalcemia. (May cause tingling, light-headedness, muscle cramps, spasms, hyperventiliation, and/or depressed cardiac function.
What is hyperkalemia?
Potassium can enter the fluid surrounding the blood as the unit ages. Intracellular K+ leaks. Can cause problems in neonates, cardiac patients, renal disease.
What is hypokalemia?
This is more likely than hyperkalemia. The RBC become calcium depleted. The patient is treated for underlying conditions.
When is coagulapathy possible?
Blood loss is replaced with RBCs and IV solutions (excess colloids and crystalloids??) and causes the dilution of platelets and clotting factors. Mortality rate is from 20-50%.
How can coagulapathy be prevented?
Monitor the platelet counts, perform an aPTT, and monitor fibrinogen.
-Replace ONLY WHAT IS NEEDED!!!!
-Sometimes the doctor must anticipate what will be needed to avoid coagulapathy.
Syphillis testing was mandated when?
In the 1950's.
In the 1960's, greater than ___% Hepatitis C cases were post-transfusion.
> than 30%
In the 1970's, about 25% of Hepatitis B cases were from transfusion. What was even higher?
Non-A and Non-B Hepatitis (NANB).
Did NANB occur more frequently in paid donors or voluntary donors?
Paid, resulting in a huge reduction of NANB and Hepatitis B when the FDA banned paid donations.
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