Blood Transfusions

What are the systemic effects of febrile hemolytic transfusion reactions?

*Hemolysis *inflammatory- WBC increased * Coagulation-DIC *renal- renal vasoconstriction, renal tubular damage * Respiratory- bronchocostriction

What are the associated side effects of asociated graft vs host disease?

*fever 7-10 days post transfusion * face/trunk rash spreading to extemities * mucositis, watery diahreaa, hepatitis, BMF

What steps to take when a transfusion reaction occurs?

- note any adverse reaction to the transfusion of blood or platelets -stop transfusion and never restart same bag o blood *clerical check *look for visible hemoglobinemia *repeat ABO and Rh testing *urinalysis *gram stain and culture for bacteria

Steps to take for septic transfusion reactions.

-check color of blood or plasma -If patient experiences rapid onset of high fever with rigors, abdominal cramping, vomiting, hypotension, shock, DIC - as soon as you suspect this stop transfusion -STAT IV antibiotics - quarantine products from same donor -alert FDA

What are the signs and symptoms of febrile hemolytic transfusion reactions?

-fever and chills -back pain -pain at infusion site -hypotension -hemoglobinuria -DIC

Describe symptoms and treatment for febrile non-hemolytic transfusion reactions?

-unexplained increased in temp - cytokines produced SS- transient fever and chills Lab- neg hemolysis Treatment- antipyretics and meripidene Prevention- leukoreduction

Describe Hemolytic Disease of the Newborn in terms of etiology, pathogenesis, morphologic findings and treatment

1. RhD - woman and RhD + women have second baby 2. They produce a RhD+ baby 3. Fetal RhD finds its way into ciruclation 4. Antibody response of IgG type anti- D+ cross the placents 5. Antibodies attack fetal RBC causing hemolysis, causing contents of RBC to be released into fetal circulation and amniotic fluid 6. Unconjugated bilirubin increases in baby and it gets depositied into the baby brain grey matter (KERNICTERUS) 7. Fetus becomes anemic because it cannot match production with loss of blood cells and erythroblasts are produced in high numbers (ERYTHROBLASTOSIS FETALIS) 8. Eventually anemia becomes so severe that heart fails and pitting edema occurs (HYDROPS FETALIS)

How could someone develop anti D antibodies?

1. Upon the second exposure of someone who is RhD+ is given to someone that is RHD- 2. If the fetus is exposed to RHD+ antibodies when it is RHD- 3. If the baby is RHD+ the mother who is RHD- will produce anti D antibodies

Explain how a persons blood type is determined?

1. You mix the blood with three different reagents including either of the three different antibodies, A, B or Rh antibodies. 2. Then you take a look at what has happened. In which mixtures has agglutination occurred? The agglutination indicates that the blood has reacted with a certain antibody and therefore is not compatible with blood containing that kind of antibody. If the blood does not agglutinate, it indicates that the blood does not have the antigens binding the special antibody in the reagent. 3. If you know which antigens are in the person's blood, it's easy to figure out which blood group he or she belongs to

List the Blood Types in the ABO blood group system

A RH+ A RH- B RH+ B RH- AB RH+ AB RH- O RH+ O RH-

What transfusion reaction is associated with granulocytes?

Febrile non-hemolytic transfusion reaction

What does a positive agglutination reaction show and result in and what will this result in in a transfusion?

For a blood transfusion to be successful, AB0 and Rh blood groups must be compatible between the donor blood and the patient blood. If they are not, the red blood cells from the donated blood will clump or agglutinate. The agglutinated red cells can clog blood vessels and stop the circulation of the blood to various parts of the body. The agglutinated red blood cells also crack and its contents leak out in the body. The red blood cells contain hemoglobin which becomes toxic when outside the cell. This can have fatal consequences for the patient. The A antigen and the A antibodies can bind to each other in the same way that the B antigens can bind to the B antibodies. This is what would happen if, for instance, a B blood person receives blood from an A blood person. The red blood cells will be linked together, like bunches of grapes, by the antibodies. As mentioned earlier, this clumping could lead to death

What Type and Rh blood can be given in trauma situations?

O Rh-

What if you are Rh+ and you donate blood to and Rh-?

The RH- person could build antibodies

If you are RH+ can you receive blood from RH-?

Yes without complication

What is the most common cause of febrile hemolytic reactions?

clerical error

The absence of the D antigen is designated as

d

When do you administer irradiated RBC's?

immunocompromised patients intrauterin, premature, neonatal hematologic malignancies and solid tumors on chemo granulocyte transfusion reaction

What is the pathology of febrile hemolytic transfusion reactions?

intra or extravascular RBC hemolysis

If you are Rh positive who can you donate blood to?

other Rh positive

What causes the pathogenesis behind using unradiated RBC's?

viable T lymphs are infused into non HLA identical hosts--> host is unable to neutralize T lymphocytes and they attack the host cell and destroy immune system

AB Blood

you have A and B antigen but no antibodies

If you belong to group A

you have A antigens on your RBCS and B antibodies in your plasma

If you belong to group B

you have B antigen on your RBCS and A antibodies in your plasma

If you belong to group O

you have neither A nor B antigen on your RBCS but you have A and B antibodies in your plasma