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Transfusions complications

Terms in this set (31)

List the five (5) leading causes of transfusion-related fatalities in order of greatest to least frequency.
The five leading causes of transfusion-related fatalities, in order of frequency, are:

(1) transfusion-related acute lung injury (TRALI);

(2) hemolytic transfusion reaction (non-ABO);

(3) microbial infections;

(4) hemolytic transfusion reaction; and

(5) anaphylaxis.
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related deaths. List the characteristics of TRALI and diagnostic criteria.
Transfusion-related acute lung injury (TRALI) is characterized by dyspnea and arterial hypoxemia secondary to noncardiogenic pulmonary edema.

The diagnosis of TRALI is confirmed when pulmonary edema occurs in the absence of left atrial hypertension and the pulmonary edema fluid has high protein content.
List five immediate actions to take when transfusion-related acute lung injury (TRALI) is suspected?
Immediate actions to take when transfusion-related acute lung injury (TRALI) is suspected include:

(1) stop the transfusion,

(2) support the patient's vital signs,

(3) determine the protein concentration of the pulmonary edema fluid via the endotracheal tube,

(4) obtain a complete blood count and chest radiograph, and

(5) notify the blood bank of possible TRALI so that other associated units can be quarantined.
The third leading cause of transfusion-related fatality is microbial infection; bacterial contamination is most likely to occur with which blood product?
Microbial infections following administration of bacterially contaminated blood product are most likely to occur in platelet concentrates.
Describe the etiology of bleeding during or following a massive blood transfusion.
The etiology of coagulopathy during massive transfusion is complex, involving dilution of factors, hypothermia, tissue hypoperfusion/ischemia, acidosis, and potential DIC.

Two of the most important factors in the coagulopathy of massive transfusion are the volume of blood given and the duration of hypotension or hypoperfusion.

Patients who are well perfused and are not hypotensive for a long period (e.g., 1 hour) can tolerate multiple units of blood without developing a coagulopathy.

The patient who is hypotensive and has received many units of blood probably has a coagulopathy from a condition that resembles disseminated intravascular coagulation (DIC) and dilution of coagulation factors from stored bank blood.
Describe the current treatment of dilutional coagulopathy.
Dilutional coagulopathy usually becomes a problem during massive transfusions. Both platelets and coagulation factors are markedly decreased and must be replaced. They should be administered after laboratory documentation of the deficiency. It is no longer accepted practice to give fresh frozen plasma (FFP) routinely after 5 units of packed red blood cell (PRBC), and it is not proper to give platelets after 10 units of PRBC. At present, dilutional coagulopathies appear to be rare, even with the transfusion of one blood volume.
What signals a febrile reaction during a blood transfusion?
An increase in temperature greater than 1 ∞C.
How do you treat a febrile reaction that develops during a blood transfusion?
Stop the blood transfusion and treat with antipyretics.
The appearance of hives in a patient receiving blood may signify what?
An allergic reaction.
The patient who has been on heparin for one week is now scheduled for surgery. What is your concern? How should the patient be prepared for surgery? Is administration of protamine an accepted therapy in this patient?
Heparin-induced bleeding can occur after about 48 hours of therapy.

Thrombocytopenia can occur in 30% of patients within 3-15 days of heparin therapy.

Treatment is infusion of platelets after temporary cessation of the heparin.

Protamine is not given due to possible histamine release, bronchoconstriction, and pulmonary hypertension.
What percentage of individuals receiving heparin therapy develop heparin-induced thrombocytopenia (HIT)?
Another controversial topic!!

Stoelting states: "mild heparin-induced thrombocytopenia occurs in 30% to 40% of patients receiving heparin... whereas severe heparin-induced thrombocytopenia occurs in 0.5-6% of patients."

Barash: "Up to 5% of patients who receive heparin therapy for 5 days will develop heparin-induced thrombocytopenia, due to antiplatelet antibodies (IgG)."

Atlee states heparin-induced thrombocytopenia occurs in 5-10% of patients receiving bovine lung heparin, and 1-3% for porcine mucosal heparin.

Take-home: appears that 5% is in common to many of these references.
A patient is bleeding postoperatively and comes back to the operating room. What do you do first? Next?
Insert large IV cannula and rehydrate. Then check coagulation factors.
What is the most common adverse reaction to blood transfusion?
A febrile reaction (fever).
What can happen to the plasma calcium concentration if vast quantities of stored blood are rapidly infused?
Citrate toxicity and hypocalcemia (due to binding of calcium by citrate) may develop.
What are two possible manifestations of citrate toxicity? What changes in cardiovascular physiology occur?
Metabolic alkalosis (caused by metabolism of citrate to bicarbonate) and hypocalcemia (caused by binding of citrate to calcium).

With hypo-calcemia, a prolongation of the Q-T interval on the ECG would be seen.

In addition, signs of decreased myocardial contractility (myocardial depression) such as hypotension, narrow pulse pressure, and elevated LVEDP, RVEDP, and central venous pressure may be seen.
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