Hemolytic Transfusion Reactions HTR

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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

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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

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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

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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 gt C up to 1-2 hours after transfusion
• chills, rigors, anxiety, vital changes

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Immediate Generalized Reactions (IGR)

• A.K.A. allergicgtanaphylactoidgtanaphylactic
• Initiating event (theory)
• Patient performed IgE
• Donor allergen
• histamine and enzymes released from mast cells

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Transfusion Related AcuteLung Injury

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

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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

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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

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Alloimmunization- HLA Antigens

• HLA antigens are found on WBCs
• 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

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TA-GVHD

• Occurs when transfused lymphocytes are allowed to
  proliferate and destroy recipient tissues
• Occurs because the recipients immune system did
  not destroy the transfused lymphocytes due to
• incompetent cellular immune system
• failure to recognize the lymphocytes as foreign

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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

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Directed Donation

• Patients select the donors from which they will
  accept blood products

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Directed Donation (Pros)

• Patient satisfaction
• Marketing
• Donor satisfaction
• New blood donors?

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Directed Donation (Cons)

• Compromised
• Interview due to pressure on donor
• Donor confidentiality
• More
• Irradiation, blood typing, clerical (donor and
  patient consent)
• Contraindications
• Fathergtmother(HDN), BMT donorgtrecipient

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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

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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

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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