Blood transfusion reactions

If die antihistamine is given for a serious situation, such as a blood transfusion reaction or a severe drug allergy, the nurse assesses die patient at frequent intervals until the symptoms appear relieved and for about 24 hours after the incident. 

Most anaphylactoid reactions are due to a direct or chemical release of histamine, and other mediators, from mast cells and basophils. Immune-mediated hypersensitivity reactions have been classified as types I-IV. Type I, involving IgE or IgG antibodies, is the main mechanism involved in most anaphylactic or immediate hypersensitivity reactions to anaesthetic drugs. Type II, also known as antibody-dependent hypersensitivity or cytotoxic reactions are, for example, responsible for ABO-incompatible blood transfusion reactions. Type III, immune complex reactions, include classic serum sickness. Type IV, cellular responses mediated by sensitised lymphocytes, may account for as much as 80% of allergic reactions to local anaesthetic. 

Type II hypersensitivity results from the formation of antigen-antibody complexes between foreign antigen and IgM or IgG immunoglobulins. One example of this type of hypersensitivity is a blood transfusion reaction that can occur if blood is not cross-matched properly. Preformed antibodies bind to red blood cell membrane antigens that activate the complement cascade, generating a membrane attack complex that destroys the transfused red blood cells. In hemolytic disease of the newborn, anti-Rh IgG antibodies produced by an Rh-negative mother cross the placenta, bind to red... 

Incompatible blood transfusion reaction Paroxysmal nocturnal hemoglobinuria Plasma transfusion reaction Malaria... 

Filtration Filtration (qv) is appHed in blood cell separation to remove leukocytes from ted blood cell (RBC) and platelet concentrates. Centtifugational blood cell separators do not reduce white blood cells (WBC) in red cell and platelet products sufficiently to avoid clinical complications such as GvHD and alloimmunization. A post-apheresis filtration step is needed to further reduce the WBC load. Modem filters are capable of a 3-log reduction in white cell contamination of the blood product, eg, apheresis single-donor platelet units having a typical white cell contamination of 5 x 10 white cells in 4 x 10 platelets can be reduced to a 5 x 10 white cell contamination, a sufficiently low number to avoid severe transfusion reactions. 

Immunologic abnormahties (eg, transfusion reactions, the presence in plasma of warm and cold antibodies that lyse red blood cells, and unusual sensitivity to complement) also fall in this class, as do toxins released by various infectious agents, such as certain bacteria (eg, Clostridium). Some snakes release venoms that act to lyse the red cell membrane (eg, via the action of phospholipases or proteinases). 

Measles, mumps, rubella MMR 0.5 mL Subcutaneous Allergic reaction to gelatin or neomycin Pregnant women Immunocompromised host Recently received a blood transfusion Severe egg allergy... 

A case report of acute arsine poisoning in which a 27-y-old man was exposed to arsine during chemical manufacturing was reported by Pinto (1976). The subject was exposed to arsine as a result of arsine production via a reaction between a galvanized bucket and an arsenic-containing sulfuric acid solution. The exposure (duration not specified) produced toxic effects characterized by abdominal cramping, thoracic discomfort, and hematuria. Over the next week, the patient s hematocrit declined from 42.5 to 27.1 and hemoglobin dropped from 14.1 to 9.5 g/dL even with medical intervention (blood transfusions and mannitol diuresis). Nine hours after exposure, blood arsenic was 159 g/dL and urinary arsenic was 1862 ug/L. 

In addition to enhancing erythropoiesis, EPO treatment also improves tolerance to exercise, as well as a patient s sense of well-being. Furthermore, reducing/eliminating the necessity for blood transfusions also reduces/eliminates the associated risk of accidental transmission of blood-borne infectious agents, as well as the risk of precipitating adverse transfusion reactions in recipients. The therapeutic spotlight upon EPO has now shifted to additional (non-renal) applications (Table 10.8). 

During blood transfusions, immune reactions can occur that destroy the erythrocytes transfused from the donor. These reactions result from the formation of antibodies (see p. 300) directed to certain surface structures on the erythrocytes. Known as blood group antigens, these are proteins or oligosaccharides that can differ from individual to individual. More than 20 different blood group systems are now known. The ABO system and the Rh system are of particular clinical importance. 

ABO blood groups—Blood types important in transfusions and transplants blood types of donor and recipient must match to prevent deadly transfusion reactions. 

Human plasma has a colloid osmotic pressure of 3.6 kPa, of which 2.8 kPa is contributed by albumin. Volume-for-volume, 4.5% albumin is approximately four times more effective in expanding the plasma volume than crystalloid solutions, and the effect lasts 6-8 hours, compared to only 15-20 min with crystalloids. Although popular in the past as volume expanders, albumin solutions have fallen into disfavour. They are prepared from pooled human plasma, with all the inherent risks of pooled blood products. Albumin can cause adverse reactions, similar to other transfusion reactions, such as chills, urticaria, and vasodilatation. These may be caused by organic or inorganic substances formed during the processing... 

Doctors and medical laboratory technicians rely on the chemical reactions between a persons blood and chemicals added to their blood sample to detect, diagnose, and treat diseases. Medical lab technicians, for example, use a chemical reaction to match blood types for blood transfusions. They also use chemical reactions to test for drug levels in the blood to show how a patient is responding to treatment. 

It is preferable but not essential to screen PBMCs from different donors to identify a donor whose cells replicate HIV efficiently and do not carry the A 32 C025 mutation. Alternatively, leukocyte enriched buffy coats may be purchased from blood transfusion centers. Mixing PBMCs from two donors results in a mixed lymphocyte reaction which can increase cellular activation and hence HIV replication. 

---