Faculty of Allied Medical Science Blood Banking (MLBB 201)

Adverse Effects of Blood Transfusion Prof. Dr. Nadia Aly Sadek Prof. in Haematology and Director of Blood Bank Centre, Medical Research Inst, University of Alexandria

ILOS By the end of this presentation, the students will recognize the most important adverse reactions caused by blood transfusion and what to do in case of incompatible blood transfusion. By the end of this presentation, the students will recognize the most important adverse reactions caused by blood transfusion and what to do in case of incompatible blood transfusion.

Hazards to the donor - Fainting: this occurs when the donor is not sitting comfortably or is anxious about the procedure. It also occurs if he has border- line blood pressure. - Anemia from repeated donations or border-line Hb.

Measures to protect the recipient - Proper donor selection, donor deferral/exclusion - Strict arm cleaning - Diversion of the first 20-30ml of blood collected e.g. for serology, testing - Microbiological testing of all donations

- Leucodepletion of cellular blood components - Post collection viral inactivation of FFP especially for at risk patients methylene blue (MB) or Solvent-detergent (SD) - Testing for bacterial contamination - Prion filtration

Agents transmitted by BT 1- Viruses : HAV, HBV, HCV, HEV, HIV, HTLV-I, HTLV-II, CMV, EBV, Parvovirus B19, West Nile virus 2- Bacteria : they are inactivated by storage at 4 degrees : Treponema pallidum and Yersinia enterocolitica 3- Exogenous: Staph. epidermidis

4- Parasites: malaria 5- Prion ’ s protein (filtration) Complications of blood transfusion may be: - acute: immediate - chronic

Immediate complications - Bacterial endotoxins may be fatal - Hypothermia, hypocalcemia especially in infants - Febrile non-hemolytic transfusion reaction (FNHTRs) - Acute intravascular hemolysis due to mis- matched blood transfusion may end by disseminated intravascular coagulation

- Urticaria - Anaplylactic shock if due to anti-IgA antibody - Circulatory overload especially in patients with heart diseases - Air embolism

Mis-matched blood transfusion Or hemolytic transfusion reaction - The patient feels pain and heat in the vein - throbbing pain in the head, flushing, nausea, lumbar pain, hypotension, shock, renal failure - rigors and fever

Management of acute HTR 1- Stop the transfusion immediately, give saline and lasix to maintain the blood flow 2- Send the bag to the blood bank and report the event 3- The blood bank should check the patient ’ s identity and documentations. 4- A sample of the patient ’ s blood should be sent to the blood bank and lab depts.

Blood bank 1- Re-do the blood grouping and cross matching 2- Direct and indirect Coombs 3- Red cells may spontaneously agglutinate on the tile Thus, ABO compatible cryoprecipitate, FFP and platelets transfusions should be selected to all patients especially children Thus, ABO compatible cryoprecipitate, FFP and platelets transfusions should be selected to all patients especially children

Because they are small and they require small volumes. Group A, B, AB plasma components are safe for blood group O recipients and not the contrary, in emergency. Unexpected ABO antibodies may arise from transfusion of incompatible plasma

Hematology and Chemistry labs 1- CBC, PT, PTT 2- Urea, creatinine, urine analysis, LDH, bilirubin (indirect) 3- Estimate the urine output, if <1ml/kg/hour hemofiltration may be necessary. 4- Give the appropriate blood component 5- Blood culture for patient and bag

Delayed hemolytic transfusion reactions They occur within 5-10 days after transfusion. They are due to IgG antibodies, there is anemia, fever and raised bibilrubin They occur within 5-10 days after transfusion. They are due to IgG antibodies, there is anemia, fever and raised bibilrubin

NH febrile transfusion reaction - Urticaria, fever, The antibodies are directed to HLA, stimulated by previous transfusions or pregnancy. Cytokines released from the WBCs into the bags during storage may produce fever after minutes after the start of transfusion.

There are chills, rigors, headache but NO - hypotension - lumbar pain - or chest discomfort TR:- Slow the rate of blood transfusion, give paramol. In the next time, give prophylactic antipyretic and filtered blood. TR:- Slow the rate of blood transfusion, give paramol. In the next time, give prophylactic antipyretic and filtered blood.

Other complications - Thrombophlebitis - Iron overload - Immune modulation - Post transfusion purpura

In U.K, screening for ABO high titre hemolysins are routinely carried out and marked on the blood bags. In U.K, screening for ABO high titre hemolysins are routinely carried out and marked on the blood bags.

Study Question How can you diagnose and manage immediate hemolytic transfusion reaction? How can you diagnose and manage immediate hemolytic transfusion reaction?

Assignments Cytometric Flow Cytometric Flow صبرى السيد عبد العزيز

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