Acute Transfusion Reactions Clinical Symptoms and Laboratory Investigation.
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Transcript of Acute Transfusion Reactions Clinical Symptoms and Laboratory Investigation.
Acute Transfusion Reactions
Clinical Symptoms and Laboratory
Investigation
Types of Transfusion Reactions
Acute Allergic Febrile Hemolytic Anaphylactic Bacterial Contamination
(Sepsis) Circulatory Overload Transfusion Related Acute
Lung Injury (TRALI)
Delayed Alloimmunization Hemolytic Transmissible Diseases Graft vs Host Disease Iron Overload Post Transfusion Purpura
Definition
Acute Transfusion Reaction: Reactions occurring at any time up to 24 hours
following a transfusion of blood or components.
The Most Common Cause of Acute Immediate Intravascular Hemolysis
Failure to identify the patient with the donor unit at the time of administration
Collecting pre-transfusion specimen from the wrong patient Incorrectly labelled specimens Unlabelled specimens that are labelled after leaving
the bedside (in the lab or at the nursing station)
Administration Guidelines (Preparation)
1. Have physician obtain informed consent and document the indications for the transfusion in the chart
2. Assess the patient’s understanding of the procedure
3. Describe the procedure, component, length of transfusion and expected outcome to the patient
4. Instruct patient to report ANY unusual symptoms immediately
Administration Guidelines (con’t)
5. Obtain and record baseline vital signs6. Assess for any pre-transfusion symptoms
which could be confused with a transfusion reaction
7. Premedicate patient with prophylactic medication as per physician’s orders
8. Use appropriate equipment9. Obtain the component from the lab
Administration Guidelines (con’t)
10. Inspect the component for leaks, abnormal cloudiness, color, clots, excessive air. Check that the component is not expired. Mix well
11. Check the physicians order for transfusion. Ensure component type is correct.
12. Do not underestimate the importance of patient and product identification that MUST occur at the bedside If the patient is not wearing a ID bracelet DO NOT proceed Contact the lab if there are ANY discrepancies
Administration Guidelines (con’t)
13. Start the infusion slowly (5 mL/minute or less for first 15 minutes) Symptoms of a severe transfusion reaction are usually
manifested during the first 50 mL or less of blood infusion If possible, remain with the patient the first 10-15 minutes of the
transfusion
14. Document the identifying individuals, date and time transfusion initiated in the chart The chart must also contain the unit identifying number, ABO/Rh
15. Keep all identification attached to the blood container until the transfusion is completed
Administration Guidelines (con’t)
16. Before leaving the bedside, remind the patient to notify you immediately if they feel anything unusual
17. Monitor and record vital signs as defined in nursing policy
18. At the end of the transfusion, record end times, volume transfused and immediate response (i.e. no reaction noted, reaction noted…)
When a Reaction is Suspected…
Signs & Symptoms
GENERAL Fever Chills Muscle ache,pain Back pain Chest pain Headache Heat at the site of infusion
or along vein
Nervous System Apprehension, impending
sense of doom Tingling, numbness
Respiratory Tachypnea Apnea Dyspnea Cough wheezing
Signs & Symptoms
Gastrointestinal Nausea Vomiting Pain, abdominal cramping Diarrhea (may be bloody)
Renal Changes in urine volume Changes in urine color
Cardiovascular Heart rate Blood Pressure Circulatory Bleeding
Cutaneous Rashes, Hives(urticaria) Itching
Signs in an Unconscious Patient
Weak Pulse Fever Hypotension Visible hemoglobinuria Increased operative bleeding Vasomotor instability
Tachycardia, brachycardia, hypotension Oliguria/anuria
Remember
Reactions from different causes can exhibit similar manifestations; therefore, every symptom should be considered potentially serious and transfusion should be discontinued until the cause is determined
Immediate Actions to Take
1. Stop the Transfusion2. Notify the attending physician and the laboratory
immediately3. Do clerical check at bedside of identifying tags and
numbers4. If symptoms are urticaria and pruritis only, consider
administering antihistimine If symptoms disappear continue transfusion
5. If additional symptoms or hives and itching do not disappear discontinue transfusion
6. Collect blood specimen and first voided urine
Immediate Actions to Take
7. Treat patient symptoms as per physician instructions Take vitals
Pulse Temperature Blood Pressure
8. Document thoroughly Complete reaction form Send form, bag, tubing and set to laboratory
What Happens in the Lab…
Laboratory Actions when Notified of Suspected
Reaction
Quarantine all other crossmatched units When Reaction form, unit, set, tubing, urine
received Centrifuge specimen Clerical Check Review Symptoms
To determine extent of investigation required
Clerical Check
Check test results vs. interpretation Check tag information with bag information
(unit number, ABO/Rh) Check Pre-transfusion specimen information
with tag information (name, number) Check that information on pre-transfusion
specimen is identical to post-transfusion
Visual Inspection
Compare plasma color of pre-transfusion and post-transfusion specimens
Is post-transfusion specimen hemolyzed? If yes, ensure that hemolysis is not due to difficult
collection (recollect if necessary) If still yes, notify physician immediately
Check contents of unit for hemolysis Check blood in tubing for hemolysis
Direct Antiglobulin Test (DAT)
To determine if there is in vivo sensitization May be negative if intravascular hemolysis has
occurred If positive, perform monospecific DAT to
determine if it is IgG, C3 or both
Extended Testing
ABO/Rh on pre and post transfusion specimens ABO/Rh on donor unit Antibody screen on pre and post transfusion
specimens Antibody Investigation, positive
DAT on pre transfusion specimen and donor unit
Reporting
Classified as to type of reaction given symptoms and investigation outcome
Should be signed off by laboratory physician or designate Reference for follow up for any attending physician
questions regarding future transfusions given the patient’s clinical need
Patient should be informed of reaction and outcome
Reporting
Should include future pre medication or special requirements, if applicable Examples
Antihistamines Anti pyretics Washed blood (when anaphylactic reactions are under
investigation and results are not back yet) Antigen negative blood if a clinically significant antibody is
identified
Reporting
Hospitals should report all severe and fatal reactions to the blood supplier Health Canada requires that CBS Head Office
advise them within 24 hours of a fatal reactions and as soon as possible (within 15 calendar days), of a life-threatening or permanently disabling reaction. To comply with this requirement, hospitals should report these types of adverse reactions immediately to their local CBS.
Future Transfusions
Patient should be notified if special requirements are necessary Antibody card
Transfusion reaction investigations and reports should be retained indefinitely by the laboratory
Risk of Suffering a Transfusion Reaction
RBC Alloimmunization: 1-2% Febrile Non-Hemolytic
to Platelets: 20-30% to RBC: 1%
Allergic (mild): 1-3% Circulatory Overload: 1% Acute Hemolytic: 1:12,500
Fatal: 1/600,000 Anaphylaxis: 1/25, 000
The Message
The risk of a severe transfusion reaction is low but health care professionals must have documented procedures for recognition and identification of the adverse effects of transfusion
The outcome Better informed patients, nurses, physicians and
laboratory personnel resulting in quality patient care