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Hemolytic Transfusion Reactions (HTR)

Hemolytic Transfusion Reactions (HTR). Fatalities 1943 Wiener 1/915 1959 Binder 1/11,625 1969 Baker 1/8,305 1990 Sazama 1/800,000 1992 Linden 1/600,000 2000 Linden 1/800,000. Transfusion Errors: Ten Years in New York State. 1/800,000 deaths 237 ABO incompatible 1/38,000

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Hemolytic Transfusion Reactions (HTR)

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  1. Hemolytic Transfusion Reactions (HTR) • Fatalities • 1943 Wiener 1/915 • 1959 Binder 1/11,625 • 1969 Baker 1/8,305 • 1990 Sazama 1/800,000 • 1992 Linden 1/600,000 • 2000 Linden 1/800,000

  2. Transfusion Errors: Ten Years in New York State • 1/800,000 deaths • 237 ABO incompatible 1/38,000 • 1/14,000 units went to the wrong patient • ALL CLERICAL ERRORS

  3. Types of Clerical Errors • Venipuncture of the wrong patient • failure to identify patient correctly • wrong name placed on sample • blood taken to the wrong patient • failure to properly identify the patient prior to transfusion

  4. Non-hemolytic Febrile Reactions (NHFR) • A.K.A. Febrile or white cell reactions • Initiating event • Patient = anti-leukocyte antibodies (HLA or neutrophil) • Donor = white cell antigens OR • Cytokines produced during storage • Result • Fever > C up to 1-2 hours after transfusion • chills, rigors, anxiety, vital changes

  5. Immediate Generalized Reactions (IGR) • A.K.A. allergic>anaphylactoid>anaphylactic • Initiating event (theory) • Patient = performed IgE • Donor = allergen • histamine and enzymes released from mast cells

  6. Transfusion Related AcuteLung Injury • Initiating event • Patient = neutrophils lining pulmonary capillaries • Donor = anti-HLA or neutrophil specific antibodies • Result = complement > neutrophil degranulation > lysosomal enzymes and oxygen free radicals • pulmonary edema, acute dyspnea, fever, hypotension • Dx: Chest X-ray, r/o fluid overload

  7. Bacterial Contamination • Initiating event • Bacteria present in small numbers at time of collection proliferate during storage - exo/endotoxin • Result • Fever, shock, nausea, vomiting • Platelets and rbc (longer storage times) • Psychrophilic “cold loving” organisms • Tx: antibiotic and ICU care

  8. Alloimmunization- RBC Antigens • Over 200 RBC antigens other than “A” or “B” • Patients with prior exposure to blood (transfusions, pregnancy or IV drug use) may develop antibodies to these other RBC antigens • These antibodies can cause hemolysis of transfused red cells or hemolytic disease of the newborn

  9. Alloimmunization- HLA Antigens • HLA antigens are found on WBC’s • Patients with prior exposure to blood (transfusions, pregnancy or IV drug use) may develop antibodies to HLA antigens • HLA antibodies can lead to destruction of transfused platelets • HLA antibodies can cause rejection of transplanted organs • Antibody rejection of organs is rare (cellular rejection more common), but difficult to treat

  10. TA-GVHD • Occurs when transfused lymphocytes are allowed to proliferate and destroy recipient tissues • Occurs because the recipient’s immune system did not destroy the transfused lymphocytes due to: • incompetent cellular immune system • failure to recognize the lymphocytes as foreign

  11. Autologous Blood • Four methods of collection (none are cost effective) • Safest blood, but not without some risk • 1/14,000 units to the wrong patient • Bacterial contamination • Improper storage

  12. Directed Donation • Patients select the donors from which they will accept blood products

  13. Directed Donation (Pros) • Patient satisfaction • Marketing • Donor satisfaction • New blood donors?

  14. Directed Donation (Cons) • Compromised: • Interview due to pressure on donor • Donor confidentiality • More $ • Irradiation, blood typing, clerical (donor and patient consent) • Contraindications: • Father>mother(HDN), BMT donor>recipient

  15. Red Cell Compatibility Testing • What is a________? • Type and screen (TS) • type and crossmatch (TC) • What risks are associated with _______? • Transfusing uncrossmatched type specific blood

  16. Type • Front type • check for blood group “A” and “B” antigens • check for Rh or “D” antigen • Back type • Check for corresponding anti- “A”, “B” or “A,B”

  17. Screen • Check for unexpected red cell antibodies • Sometimes found in patients with a h/o pregnancy or transfusions • These antibodies can cause hemolytic reactions or hemolytic disease of the newborn

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