Transfusion reactions Doctor Omid Reza Zekavat1

Transfusion reactions TreatmentEvaluationPresentationEtiologyType Supportive care DCT, PBS,U/A, LFT, BUN/ Cr, PT/PTT Fever, hemoglobinuria, nausea/vomiting, pain, DIC ABO incompatibilityHemolytic (immune) Supportive carePBS, negative DCT HemoglobinuriaPhysical or chemical destruction Hemolytic (non-immune) Antipyretic, Prevention: LD- product, premedication R/O hemolysis Nausea/ vomiting, chills/rigors Anti body to donor WBC or plasma protein Fever/Chill Antihistamines to epinephrine Response to antihistamines Urticaria,pruritis to RDS, hypotension Antibody to plasma proteins Allergic (mild to severe) SupportiveBlood cultureFever/chills, shockMost frequent in Plt Bacterial contamination Doctor Omid Reza Zekavat

Delayed transfusion reactions Occur 5-14 days after transfusion Characterized by unexpected levels of anemia, as well as malaise and jaundice Due to an alloantibody that was not detectable at the time of transfusion Investigate the presence of a new antibody Doctor Omid Reza Zekavat3

Transfusion-related acute lung injury (TRALI) Severe complication Specific anti-neutrophil or anti-HLA antibodies Characterized by dyspnea, tachycardia, fever and hypotension during or within six hours of transfusion. chest radiograph shows bilateral infiltrates typical of pulmonary edema Management includes oxygen, administration of steroids and diuretics when needed, assisted ventilation. Doctor Omid Reza Zekavat4

Transfusion-induced graft versus host disease (TI-GVHD) Caused by viable lymphocytes in units of transfused red cell. rare but often fatal Immunosuppressed patients are at particular risk Immunocompetent recipients of red cells from a haploidentical donor such as a family member. Occurs within 1-4 weeks of transfusion Characterized by fever, rash, liver dysfunction, diarrhea and pancytopenia due to bone marrow failure. Donated blood from a family member should be avoided or if used should always be irradiated before transfusion. Leucodepletion alone is inadequate for the prevention of this complication. Doctor Omid Reza Zekavat5

Patients need irradiated products Cellular immunodeficiency Intrauterine transfusion / Exchange transfusion Blood component from related donor Hematopoietic cell transplant recipients Receiving HLA-matched cellular blood component Hematologic or lymphatic malignancies Cancer on chemotherapy Irradiated RBC make lymphocyte inactivated and result in fade of GVHD complication. Doctor Omid Reza Zekavat6

Transfusion-associated circulatory overload Occur in the presence : recognized or unrecognized cardiac dysfunction when the rate of transfusion is inappropriately fast Signs and symptoms include dyspnea and tachycardia. Treatment focuses on volume reduction and cardiac support Doctor Omid Reza Zekavat7

Transfusion transmitted disease  HIV 1/ 2  Screening test: NAT ( nucleic acid amplification)  Window period: 11 days  HTLV-I-II  Screening test: Anti-HTLV  Window period: 51 days  HCV  Screening test: NAT ( nucleic acid amplification)  Window period: 10 days  HBV  HBS Ag  Window period: 59 days Doctor Omid Reza Zekavat8

Transfusion transmitted disease Newly emerging infectious agents (WNV, SARS, Avian Flu, prions) parasitic protozoa: Chaga’s disease, toxoplasmosis and babesiosis Doctor Omid Reza Zekavat9

CMV infection Patient at risk for: Congenital immune deficiency AIDS Hematopoietic cell transplant recipients Organ transplant Premature infant Cancer patients on chemotherapy Intrauterine transfusion Doctor Omid Reza Zekavat10

Case-1 پسری 12 ساله ده دقیقه پس از دریافت خون دچار تب 38.5 میشود، در کودک مورد نظر : اولین پیشنهاد درمانی شما؟ قطع تزریق خون برای تایید تشخیص خود آزمایشهای مورد استفاده کدام است؟ آزمایش خون محیطی، آزمایش ادرار، آزمایش DCT ، BUN&CR ، LFT ، PT&PTT در صورتی که تشخیص همولیز رفع شد ، برای بیمار فوق پیشنهاد چیست؟ ضد تب ، شروع مجدد تزریق با سرعت کمتر ، دادن ضد تب در دفعات بعدی تزریق Doctor Omid Reza Zekavat11

Case-2 بیمار تالاسمی 8 ساله شما به تازگی بد دنبال دریافت خون دچار راش پوستی و تنگی نفس ملایم میگردد : در این بیماران شایعترین علت؟ حساسیت به پروتین های موجود در پلاسما. توصیه ابتدایی به این بیمار؟ استفاده از آنتی هیستامین قبل از تزریق خون. اگر در این بیمار فوق با توصیه شما در بار بعدی دچار تنگی نفس شدید شد پیشنهاد شما ؟ استفاده از خون شسته شده. Doctor Omid Reza Zekavat12

Case-3 بیمار تالاسمی مورد درمان مرکز شما به علت سرطان خون تحت شیمی درمانی قرار گرفته است در بیمار فوق باید به چه احتمال عفونی در زمان تزریق خون بعدی توجه کرد؟ عفونت با CMV برای جلوگیری توصیه شما چیست؟ استفاده از خون WBC reduced Pre-storage Doctor Omid Reza Zekavat13