Adverse Effect of Blood Transfusion - PowerPoint PPT Presentation

ostinmannual
slide1 n.
Skip this Video
Loading SlideShow in 5 Seconds..
Adverse Effect of Blood Transfusion PowerPoint Presentation
Download Presentation
Adverse Effect of Blood Transfusion

play fullscreen
1 / 35
Download Presentation
Adverse Effect of Blood Transfusion
489 Views
Download Presentation

Adverse Effect of Blood Transfusion

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

    1. Adverse Effect of Blood Transfusion ??.?.?.?????? ?????????? ????????????? ????????????? ??????????????????

    2. 30/11/2549 MD-3 /49 2 Transfusion Reaction is any unfavorable transfusion-related event occurring in a patient during or after transfusion of blood components

    3. 30/11/2549 MD-3 /49 3 Immediate and Delayed Transfusion Reaction

    4. 30/11/2549 MD-3 /49 4

    5. 30/11/2549 MD-3 /49 5 Signs and Symptoms of AHTR Chills , fever Facial flushing Hypotension Renal failure DIC Chest pain Dyspnea Generalized bleeding Hemoglobinemia Hemoglobinuria Shock Nausea Vomitting Back pain Pain along infusion vein

    6. 30/11/2549 MD-3 /49 6 Acute Hemolytic Transfusion Reactions

    7. 30/11/2549 MD-3 /49 7 Pathophysiology Two mechanisms for RBCs destruction 1) Intravascular hemolysis 2) Extravascular hemolysis

    8. 30/11/2549 MD-3 /49 8 Management of AHTR Stop the transfusion Keep IV fluid Notify patients physician and blood bank Take care of patient Perform bedside clerical checks Return unit, set to blood bank Collect appropriated post transfusion blood sample for evaluation Document reaction

    9. 30/11/2549 MD-3 /49 9 Laboratory investigation for AHTR sample from blood bag Repeat ABO, Rh, Ab screening Patient sample Pre Tx sample Repeat ABO, Rh, Ab screening Post Tx sample Repeat ABO, Rh, Ab screening, DAT, CBC, UA, Bilirubin, BUN, Cr, Coagulation screening Repeat compatibility test - Pre Tx sample & Donor unit - Post Tx sample & Donor unit

    10. 30/11/2549 MD-3 /49 10 Treatment of AHTR Depends on Amount of incompatible blood transfused Specificity of the offending antibody Clinical severity of the reaction

    11. 30/11/2549 MD-3 /49 11

    12. 30/11/2549 MD-3 /49 12

    13. 30/11/2549 MD-3 /49 13

    14. 30/11/2549 MD-3 /49 14

    15. 30/11/2549 MD-3 /49 15 Delayed Hemolytic Transfusion Reaction Most often the result of an anamnestic response (transfusion, pregnancy, transplantation ) Mild clinical signs and symptoms Unexpected or unexplained decreased in Hb or Hct after transfusion should be investigate as possible DHTR

    16. 30/11/2549 MD-3 /49 16 Delayed Hemolytic Transfusion Reaction Pathophysiology - 2 types of DHTR 1) secondary (anamnestic) response to transfused RBCs ?3 7 day after Tx 2) primary alloimmunization longer - Extravascular hemolysis sensitized RBCs ? removed by RES

    17. 30/11/2549 MD-3 /49 17 Delayed Hemolytic Transfusion Reaction Signs & Symptoms mild fever or fever with chill mild anemia mild to moderate jaundice Uncommon ? hemoglobinemia, Hemoglobinuria, shock, renal failure

    18. 30/11/2549 MD-3 /49 18 Delayed Hemolytic Transfusion Reaction Therapy and Prevention - Goal of therapy is prevention - Treat severe complication if necessary - Alert to history of sensitization (previous transfusion, Pregnancy, transplantation)

    19. 30/11/2549 MD-3 /49 19 Febrile Nonhemolytic Transfusion Reaction ( FNHTR) Definition 1oC temperature rise associated with transfusion, no medical explanation other than blood transfusion

    20. 30/11/2549 MD-3 /49 20 Pathophysiology of FNHTR - Patients Leukocyte antibodies (HLA Ab) - Blood donors leukocytes in transfused blood

    21. 30/11/2549 MD-3 /49 21 Febrile Nonhemolytic Transfusion Reaction Signs & Symptoms Fever with or without chills most symptoms are mild severe reaction :- hypotension, cyanosis, tachycardia, tachypnea, dyspnea, cough etc.

    22. 30/11/2549 MD-3 /49 22

    23. 30/11/2549 MD-3 /49 23 Allergic Transfusion Reactions Probably the most frequent kind of reaction Pathophysiology Allergen Reagin (IgE,IgG) complex attach mast cell histamine/leukotrienes Allergic reactions (urticaria)

    24. 30/11/2549 MD-3 /49 24 Allergic Transfusion Reactions Signs & Symptoms - Urticaria - severe reactions are rare Therapy & Prevention - Antihistamine - Plasma deficient blood components

    25. 30/11/2549 MD-3 /49 25 Anaphylactic and Anaphylactoid reactions Anaphylaxis can range from mild urticaria to severe shock and death Pathophysiology - IgE antibody to IgA in donor plasma (anti-IgA antibodies)

    26. 30/11/2549 MD-3 /49 26 Anaphylactic and Anaphylactoid reactions Signs & Symptoms - Anaphylactic ? coughing, dyspnea, nausea, emesis, bronchospasm, flushing of skin, chest pain, hypotension, abdominal cramps, diarrhea, shock, and death. - Anaphylactoid (less severe) ? urticaria, periorbital swelling, dyspnea, or perilaryngeal edema

    27. 30/11/2549 MD-3 /49 27 Anaphylactic and Anaphylactoid reactions Therapy and Prevention Stop transfusion Keep IV line open Medication :- epinephrine, corticosteroid Wash RBCs and blood components Transfuse IgA deficiency blood

    28. 30/11/2549 MD-3 /49 28 Transfusion-related Acute Lung Injury (TRALI) Pathophysiology Leukocyte Ab in donor react with pt. leukocytes Activate complements Adherence of granulocytes to pulmonary endothelium with release of proteolytic enz.& toxic O2 metabolites Endothelial damage Interstitial edema and fluid in alveoli

    29. 30/11/2549 MD-3 /49 29 Transfusion-related Acute Lung Injury (TRALI) Acute and severe type of transfusion reaction Symptoms and signs Fever Hypotension Tachypnea Dyspnea Diffuse pulmonary infiltration on X-rays Clinical of noncardiogenic pumonary edema

    30. 30/11/2549 MD-3 /49 30 Transfusion-related Acute Lung Injury (TRALI) Therapy and Prevention Adequate respiratory and hemodynamic supportive treatment If TRALI is caused by pt. Ab ? use LPB If TRALI is caused by donor Ab ?no special blood components

    31. 30/11/2549 MD-3 /49 31 Transfusion-associated Circulatory Overload (TACO) Patients at significant risk Children Elderly patients Chronic anemia Cardiac disease Thalassemia major or Sickle cell disease

    32. 30/11/2549 MD-3 /49 32 Pathophysiology

    33. 30/11/2549 MD-3 /49 33 Symptoms and Signs Dyspnea Coughing Cyanosis Orthopnea Chest discomfort Headache Restlessness Tachycardia Systolic hypertension increase > 50 mm.Hg

    34. 30/11/2549 MD-3 /49 34 Therapy & Prevention Rapid reduction of hypervolemia Respiratory and cardiac support Oxygen therapy Diuretic Therapeutic phlebotomy - Use appropiate transfusion rate - Use appropiate blood components

    35. 30/11/2549 MD-3 /49 35 Metabolic Reaction Citrate toxicity Hyperkalemia Hypothermia Coagulopathy in massive transfusion Air embolism

    36. 30/11/2549 MD-3 /49 36 Transfusion-associated Graft-versus-Host Disease ( TA-GVHD) Patient at risk

    37. 30/11/2549 MD-3 /49 37 Transfusion-associated Graft-versus-Host Disease ( TA-GVHD) Pathophysiology Infusion of Immunocompetent Cells (Lymphocyte) Patient at risk proliferation of donor T lymphocytes attack against patient tissue

    38. 30/11/2549 MD-3 /49 38 Graft-versus-Host Reaction Signs & Symptoms

    39. 30/11/2549 MD-3 /49 39 Graft-versus-Host Reaction Therapy

    40. 30/11/2549 MD-3 /49 40 Iron overload

    41. 30/11/2549 MD-3 /49 41 Posttransfusion Hemosiderosis Affected organ :- heart, liver, endocrine glands Signs & Symptoms - muscle weakness, fatigue, weight loss, mild jaundice, anemia, mild diabetes, and cardiac arrhythmia Therapy ? Iron chelating agent Prevention ? transfuse with young RBCs

    42. 30/11/2549 MD-3 /49 42 Alloimmunization Result from prior exposure to donor blood components Significant complication ?even small amount of blood Adverse effects may include difficulty in finding compatible blood transfusion reaction platelet refractoriness

    43. 30/11/2549 MD-3 /49 43 Alloimmunization Pathophysiology 1st exposure ? moderate production IgM and IgG antibody by foreign antigens 2nd exposure ? rapid production of large amount of IgG

    44. 30/11/2549 MD-3 /49 44 Alloimmunization Signs & Symptoms mild ? slight fever and Hb severe ? platelet refractoriness with bleeding Therapy & Prevention depends on type and severity

    45. 30/11/2549 MD-3 /49 45 Posttransfusion Purpura Rare complication Rapid onset of thrombocytopenia as a result of anamnestic production of platelet alloantibody Usually occurs in multiparous woman

    46. 30/11/2549 MD-3 /49 46 Posttransfusion Purpura Pathophysiology Platelet Ab (anti-PLA1) ?attach platelet surface ? destruction by RES Signs & Symptoms Purpura and thrombocytopenia occur ~ 1 2 weeks after transfusion

    47. 30/11/2549 MD-3 /49 47 Posttransfusion Purpura Therapy and Prevention Corticosteroids Exchange transfusion Plasmapheresis

    48. 30/11/2549 MD-3 /49 48 Bacterial contamination reaction Cause gram ve, gram +ve bacteria most frequent Yersinia enterocolitica Pathophysiology Bacteria growing in cold temperature Produced endotoxin

    49. 30/11/2549 MD-3 /49 49 Symptoms & Signs Acute onset within ~ 30 min after transfusion Dryness and flushing skin Fever, hypotension, shaking chills, muscle pain, vomitting, abdominal cramps, bloody diarrhea, hemoglobinuria, shock, renal failure, and DIC.

    50. 30/11/2549 MD-3 /49 50 Therapy & Prevention Broad spectrum antibiotics Symptomatic treatment Prevention Phlebotomy and blood components preparation & processing , thawing by sterile technique.

    51. 30/11/2549 MD-3 /49 51 Transfusion Transmitted Diseases Viral Infections Hepatitis Viruses :- HBV, HCV Retroviruses :- HIV Herpesviruses :- CMV, EBV Parvovirus :- Human B19 parvovirus Prion :- infectious particle of CJD

    52. 30/11/2549 MD-3 /49 52 Transfusion Transmitted Diseases Bacterial Infection Gram negative and positive Syphilis Lyme disease (Borrellosis)

    53. 30/11/2549 MD-3 /49 53 Transfusion Transmitted Diseases Parasitic Infections Malaria Chagas disease Toxoplasmosis Leishmaniasis

    54. 30/11/2549 MD-3 /49 54 Serological Testing for Infectious markers HIV Ag Anti HIV HBsAg Anti HCV Test for syphilis

    55. 30/11/2549 MD-3 /49 55 Steps to take when a transfusion reaction occurs Stop the transfusion immediately Leave the needle in the vein and begin infusing normal saline Obtain vital signs Begin O2 if pulmonary symptoms are prominent Carry out PE : lung, heart, skin, signs of abnormal bleeding

    56. 30/11/2549 MD-3 /49 56 Steps to take when a transfusion reaction occurs Obtain a new blood sample for repeat RBC compatibility test and inspection for hemolysis Obtain a urine sample if the patient can void Obtain a chest x-ray if pulmonary symptom are prominent Make a preliminary assesment of the situation Begin definitive treatment

    57. 30/11/2549 MD-3 /49 57 TAKE CARE YOUR PATIENTS WITH BLOOD TRANSFUSION