Transfusion Reaction and Coombs Test: Moderator:-Dr Sanjay Agrwal Presenter: - DR Pratima Singh PG Jr-1

Transfusion reaction and coombs test
Moderator:- Dr Sanjay Agrwal

Presenter:- Dr pratima Singh
Pg Jr-1
Transfusion reaction
Definition:-Any unfavorable and harmful transfusion
related events occurring in the patient during or after
transfusion of blood or component is called
transfusion reaction
• Causes of transfusion reaction:- 1. Clerical error
Inadequate labeling
Wrong blood issued
2 . Technical errors:- Error in blood grouping & cross matching.
• Incorrect interpretation of test results.

3. Others:- Blood contamination during phlebotomy.
• Blood infusion with small bore needle .
• Blood cooler to – 30° or warmed to >40°c.
• Concomitant administration blood & drug with commonest.
Acute (<24 hr) Delayed (>24hr) Main causes of transfusion
related death
Acute hemolytic transfusion Delayed hemolytic Immediate acute hemolytic

reaction transfusion reaction transfusion reaction
Febrile non hemolytic Transmission of infection Pulmonary edema&

reaction congestive heart failure
Allergic reaction Iron overload Bacterial contamination

Anaphylactic reaction
Transfusion associated lung Graft vs host disease Transfusion of physically

injury damaged red cells
Volume overload Post transfusion purpura Transfusion associated graft

vs host disease
Immediate management of category 2: moderately sever
reaction
• Stop the transfusion and keep IV line open with normal saline in another site.
• Return the blood unit with transfusion administration set.
• Administration of Antihistamine IM and oral . Avoid the aspirin in
thrombocytopenic patients.
• Give IV corticosteroids and bronchodilators if there are anaphylactic features.
• If clinical improvement occur ,restart transfusion slowly with new blood unit and
observe carefully.
• If no clinical improvement within 15 min or symptom worsen,treat as cat 3.
Immediate management of category 3: life threatening
reaction
• Stop the transfusion and keep IV line open with normal saline in another site.
Maintain airway and give high flow oxygen by mask.
• Give adrenaline 0.01mg/kg body weight by slow IM injection.
• Give IV corticosteroids and bronchodilators.
• Give diuretics: eg frusemide 1mg / kg/IV .
• Notify the senior doctor attending the patient, and blood centre.
• Start a 24 hr urine collection and record all intake and output.
• Asses the bleeding from puncture sites or wounds.if there is clinical or laboratory
evidence of DIC , give platelets (4-6 unit) and either cryoprecipitate ( adult: 12
unit) or FFP ( adult:3units)
• Continued……..
Reasses . If hypotensive _ give further saline.
Give inotrops, if available.
If urine output falls or :- maintain fluid balance accurately .
Give further diuretics:eg frusemide 1 mg/kg IV or equivalent.
Consider dopamine infusion , if available.
If bacteremia is suspected ( rigor,fever,collapse,no evidence of a
hemolytic reaction), start a broad – spectrum antibiotic IV.
Acute hemolytic transfusion reaction:- results from destruction of
transfused RBC by preformed antibodies in the recipient.
Occur during immediately.
Common error are collection of blood ( grouping &cross matching) from the wrong
patient, incorrect labeling of sample , transfusion of blood to the wrong patient and
issue of wrong unit from the blood bank.
Sign&symptom:- fever,pain at the infusion site,loin or back pain ,oozing from
venepuncture site , tachycardia, hemoglobinuria , hypotension.
Laboratory studies:- hemoglobinemia , positive direct anti globulin test ,
hemoglobinuria, schistocytes, increase indirect serum bilirubin.
Febrile Non – hemolytic transfusion reaction
• Most common transfusion reaction.
• It is defined as unexplained rise of temperature of at least 1°c during or shortly
after transfusion.
• It is caused by release of pyrogenic cytokines from white cells.
• Sign & symptom:- fever , chills and tachycardia, headache, vomiting.
Management:- Antipyretics ( acetaminophen).
Prevention:- Use leukoreduced blood components.
Bacterial contamination of donor unit:- contamination of donor unit
are transient bacteremia in an asymptomatic donor .
• It is more common with platelet concentration & store at higher temperature

(20_24°c)that promotes multiplication of contaminating bacteria.
• Platelet are usually contaminated by _ staphylococcus species, bacillus cereus.
• Red cell (4-6°c) are usually contaminated by _ yesenia enterocolitis,
pseudomonas fluorescence.
Sign& symptom:- high grade fever with rigor ,hypotension , shock thus mimicking
acute hemolytic transfusion reaction.
Laboratory studies:- inspection of blood bag discoloration,
clots,cloudiness,hemolysis, gram staining & culture of blood from the blood bag &
from the recipient.
Transfusion – associated lung injury:- it is reaction of anti- HLA or
anti neutrophil antibodies in donor blood with leukocyte of recipient leading to the
formation of leukocyte aggregates, these aggregates deposit in pulmonary
vasculature and cause increased vascular permeability & pulmonary edema.
• Sign&symptom:- hypoxemia, respiratory failure, hypotension , fever, bilateral
pulmonary edema.
Management:- supportive care until recovery.
Transfusion- associated graft – versus host disease
It is mediated by immunocompetent lymphocytes present in blood product that mount

immunologic response against the recipient.
Immunocompromised recipient and recipient receiving blood from related donors who share
similar HLA phenotypes are at high risk of developing TA- GvHD .
Sign&symptom:- erythematous maculopapular rash, vomiting, diarrhea & abnormal liver
function.
Anaphylactic reaction:- This is occur in IgA deficient recipients in whom
anti IgA antibodies react with IgA in donor plasma,leading to activation of
complement& formation of anaphylatoxins (c3a,c5a)
• Sign & symptom:- acute hypotension, shock,dyspnea after transfusion

of a few drop of blood .
Allergic reactions
This result from type 1 hypersensitivity reaction to some donor plasma
proteins.
Sign & symptom:- mild urticaria, rash, pruritus develop within seconds.
Management:- Antihistamines.
Transfusion associated circulatory overload:- it is occur if transfusion rate is
too rapid ,excessive cardiac & renal impairment is present.
• It causes cardiac failure and lung edema.
Sign & symptom:- Dyspnea, peripheral edema, cough, tachycardia, hypertension.
Management:- upright posture oxygen, diuretics.
Iron overload ( transfusion hemosiderosis)

Iron load in transfusion dependent patient receiving multiple RBC transfusion.
Iron intake exceed, iron excretion excess is deposited in parenchymal organs,
which may interfere with organ function.
Sign& symptom:- diabetes, cirrhosis, cardiomyopathy
Management:- iron chelating agent ( deferoxamine or deferiprone)
Post transfusion purpura:- the recipient antibodies directed against the
platelet antigens . Sudden thrombocytopenia and bleeding develop 5- 12 days after
the transfusion.
Donor platelet posses high incidence HPA-1a antigen while this antigen is
lacking on patients platelet.
Mechanism of destruction of HPA-1a negative platelet is not known
Management:- give the high dose corticosteroids.
Give high dose of IV immunoglobulin 2g/kg for 5 days.
Plasma exchange.
Monitor the patient platelet count.
Recovery of platelet count after 2-4 week is usual.
Delayed hemolytic transfusion reaction:- occur after several days or weeks
after transfusion. Who have been sensitized to a red cell antigen by previous transfusion.
• On exposure there is a secondary IgG immune response & mainly extra vascular
hemolysis.
Sign& symptom:- fever ,mild jaundice, mild anemia , hypotension, oliguria.
Laboratory features:_ raised indirect serum bilirubin, spherocytes on blood smear,
decreased Hb level , positive anti globulin test.
Management:- identification of implicated antibodies and transfusion of antigen-
negative units.
Complications associated with massive transfusion:- massive
transfusion Refers to transfusion of stored blood equivalent to patients blood
volume in 24 hrs.
• Rapid transfusion of large volumes of stored blood leads to :- dilution of platelets

and coagulation factors.
• Hyperkalemia ( due to release of potassium from stored red cells )
• Hypocalcemia ( due to binding of calcium by citrate)
• Hypothermia ( due to rapid infusion of large amount of cold blood )
• Adult respiratory distress syndrome due to migration of micro aggregates to
lungs.
Transmission of infection:-
• HIV , Hep B, Hep C , syphilis, maleria.
Cytomegalovirus
human parvovirus B19 ,brucellosis,
Epstein barr virus, toxoplasmosis,changes disease, infectious
mononucleosis & lyme‘s disease.
Bibliography
• Essentially of clinical pathology

• Robbins and Cotran basic pathology
• Clinical transfusion practice (WHO)

Transfusion Reaction and Coombs Test: Moderator:-Dr Sanjay Agrwal Presenter: - DR Pratima Singh PG Jr-1

Uploaded by

Copyright:

Available Formats

Transfusion Reaction and Coombs Test: Moderator:-Dr Sanjay Agrwal Presenter: - DR Pratima Singh PG Jr-1

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Transfusion Reaction and Coombs Test: Moderator:-Dr Sanjay Agrwal Presenter: - DR Pratima Singh PG Jr-1

Uploaded by

Copyright:

Available Formats

Transfusion reaction and coombs test

Moderator:- Dr Sanjay Agrwal

• Incorrect interpretation of test results.

Acute hemolytic transfusion Delayed hemolytic Immediate acute hemolytic

Febrile non hemolytic Transmission of infection Pulmonary edema&

Allergic reaction Iron overload Bacterial contamination

Transfusion associated lung Graft vs host disease Transfusion of physically

Volume overload Post transfusion purpura Transfusion associated graft

• It is more common with platelet concentration & store at higher temperature

It is mediated by immunocompetent lymphocytes present in blood product that mount

• Sign & symptom:- acute hypotension, shock,dyspnea after transfusion

Iron overload ( transfusion hemosiderosis)

• Rapid transfusion of large volumes of stored blood leads to :- dilution of platelets

• Essentially of clinical pathology

You might also like