Reaction transfusion

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. 

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. 

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). 

Is there any evidence of adverse events from the resuscitation therapies employed such as fluid overload, electrolyte disturbances, transfusion reactions, and/or alterations in coagulation If yes, manage the particular adverse event accordingly. 

Sickle cell hemolytic transfusion reaction syndrome is a unique problem in SCD patients. Owing to alloimmunization, an acute or delayed transfusion reaction may occur. Delayed reactions typically occur 5 to 20 days after transfusion. Alloantibodies and autoantibodies resulting from previous... 

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). 

Chronic transfusion is indicated to prevent stroke and stroke recurrence in children. Transfusion frequency is usually every 3 to 4 weeks and should be adjusted to maintain HbS of less than 30% of total hemoglobin. The optimal duration is unknown. Risks include alloimmunization, hyperviscosity, viral transmission (requiring hepatitis A and B vaccination), volume and iron overload, and transfusion reactions. 

Allergic states Control of severe or incapacitating allergic conditions intractable to conventional treatment in serum sickness and drug hypersensitivity reactions. Parenteral therapy is indicated for urticarial transfusion reactions and acute noninfectious laryngeal edema (epinephrine is the drug of first choice). 

Adults and children older than 2 years of age Usual dose is 25 mg at bedtime 12.5 mg before meals and at bedtime may be given, if necessary. Single 25 mg doses at bedtime or 6.25 to 12.5 mg taken 3 times daily will usually suffice. Doses of 25 mg will control minor transfusion reactions of an allergic nature. 

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

Allergic rhinitis, anaphylaxis, urticarial transfusion reactions, urticaria PO 4 mg... 

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. 

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... 

Autoantibodies as a Cause of Acquired Hemolytic Anemia and Hemolytic Transfusion Reactions Biologic Test with Bovine Red Cells, Ann. Internal Med. (1956) 44,221. 

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... 

Tonn T, Schalling S, Schmiedeberg S, et al. 2001. Diethylhexylphtalat (DEHP) and tolylene 2,4-diisocyanate (TDI) do not account for the high incidence of nonhemolytic transfusion reactions [Abstract], P314. 

Fresh frozen plasma (FFP) 250 ml at six-hour intervals (10-20 ml/kg BW = 1,000-1,500 ml/day). Administration of 10 ml/kg BW (about 600-1,200 rnl) serves to elevate the concentrations of coagulation factors and inhibitors by 15—20%. The half-life of factor VII is only 6 hours, which is why dosage intervals of 6 to 12 hours must be maintained. IgA deficiency is a known contraindication. Adverse transfusion reactions may occur with a frequency of 1-5% of cases. Improvement in coagulopathy generally lasts 1 to 2 days. Caution is called for, since accentuated coagulation entails the danger of thrombosis (if necessary, AT III replacement of up to 60-80%), and an overload of the intra-... 

Blood transfusion is frequently associated with mild allergic reactions more serious hemolytic transfusion reactions, transfusion-related acute respiratory distress syndrome, and even fatal acute hemolytic transfusion reactions are rare but do exist. Finally, administrative errors remain one of the main causes of transfusion-related morbidity and mortality. 

Favorable results of exchange transfusion in a variety of diseases in adults, for example sickle cell disease, severe clotting disorders, hepatic failure, and acute hemolytic transfusion reactions, have been published (1). Today, however, machine apheresis procedures are more effective and safer for patients requiring exchange of cellular elements or plasma. Exchange transfusion is the most effective therapeutic procedure in the treatment of hemolytic disease of the newborn. Bilirubin removal prevents damage to the central nervous system caused by hyperbilirubinemia. In addition, sensitized erythrocytes are replaced by normally surviving cells and anemia is corrected. 

Hemolytic post-transfusion reactions (50) are most often caused by clerical and administrative errors involving misidentification (incorrect labeling of blood samples, erroneous identification of patients) rather than by mistakes in the laboratory (2,51). However, scrupulous care is demanded at all stages in a review of hemolytic and other transfusion reactions, the importance of competent handling of whole blood and red cell suspensions (including the avoidance of freezing or osmotic damage) has been stressed (52). 

Hemolysis mediated by immune reactions is usually avoided by routine antibody screening and crossmatching methods. Improved pre-transfusion testing has resulted in a significant decrease in the incidence of hemolytic transfusion reactions, although there are examples of transfusion reactions having occurred where no antibody was detectable either before or after transfusion (53). 

When the signs and symptoms of a hemolytic transfusion reaction occur more than 24 hours after transfusion, the reaction is classified as a delayed reaction (60-62). It is estimated that up to 0.025% of recipients may well be at risk of delayed transfusion reactions (1) however, in one study only 1 in 10 668 transfused units cause delayed hemolysis. The severity of this type of reaction varies widely. Many of these reactions are so mild that they remain unnoticed only a few are severe or fatal. Almost all patients with this type of complication have a history of previous transfusion and/or pregnancy, which has made sensitization possible. The symptoms comprise fever, chills, anemia, hemoglobinemia, hemoglobinuria, and reticulocytosis. Renal insufficiency can occur and the direct antiglobulin test is positive. 

Reports of delayed transfusion reactions continue to appear and confirm the difficulty of diagnosis. Many allo-antibodies responsible for delayed reactions of various severity have been demonstrated (61,63-69). The specificities include the usual Kidd and Rh antigens/anti-bodies and anti-S. Delayed reactions to the Kell antigens, for example Js(a,b), have been reported (68,69), and anti-FF(b) has also been found to cause a delayed reaction (63). A delayed reaction may occur because of anti-Al production from the group O graft and the reduction of suppressor cell activity by immunosuppressive agents (70). In sickle cell patients a more severe delayed transfusion reaction can be misdiagnosed as sickle cell crisis (71,72). This occurs particularly in patients with U variants (73). 

The interpretation of delayed transfusion reactions can be difficult, as the occurrence of low-grade warm acquired hemolytic anemia can resemble this form of transfusion reaction (78). Careful elution of antibody, its identification, and elucidation of its relation to the transfused erythrocytes are required to establish the nature of the reaction. If the indirect antiglobulin test is negative, autoimmune hemolysis is the likely pathogenic mechanism (79). 

Passive transfer of allo-antibodies present in donor plasma can also cause hemolytic transfusion reactions. Low-titer erythrocjde antibodies in donor blood are considered to be relatively harmless, especially when plasma-reduced or concentrated eiythrocytes are transfused in a recipient whose cells carry the relevant antigen. A comphcation of this type provoked by high-titer anti-E antibody has been described (90). Likewise, a hemolytic transfusion reaction occurred in a Kell-negative adult when anti-KeU contained in the plasma of a unit of whole blood reacted with Kell-positive cells transfused 4 weeks before (91). 

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