Transfusion Reactions

Author: Erin Tretter, MBA, MLS(ASCP)
Reviewer: Joshua J. Cannon, MS, MLS(ASCP)CMSHCM and Barbara Cebulski, MS, MLS(ASCP)
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Continuing Education Credits

P.A.C.E.® Contact Hours: 1 hour(s)

Florida Board of Clinical Laboratory Science CE Credit Hours

Florida Board of Clinical Laboratory Science CE - General (Blood Banking / Immunohematology): 1 hour(s)

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What are the risks associated with blood transfusion? As a laboratory professional involved in blood preparation for transfusion, do you know what steps you can take to minimize those risks? If a patient starts to exhibit various symptoms during or after a transfusion, would you know how to interpret those symptoms and what actions to take to prevent harm to the patient? These are all important questions that are asked and answered by our new course, Transfusion Reactions. This course covers important types of transfusion reactions, including acute hemolytic transfusion reactions, transfusion-related acute lung injury, and transfusion-associated graft versus host disease. If you are a part of the health care team that is involved in the processing and administration of blood products, this course will reinforce those policies and procedures that you may already know, but are important to review. This course will update your knowledge about the various types of reactions that occur and their associated symptoms. Even though you may not be involved in the clinical part of the transfusion process, it is important to understand the big picture to recognize how important your job is to ensure patient transfusion safety.

Objectives

  • Define transfusion reaction.
  • Identify the risks of transfusions.
  • Compare and contrast immediate hemolytic transfusion reactions and delayed hemolytic transfusion reactions.
  • List and define the types of nonhemolytic transfusion reactions.
  • List the laboratory findings associated with hemolytic and nonhemolytic transfusion reactions.
  • Discuss the definition, pathophysiology, signs, symptoms, therapies, prevention, and clinical work-up of hemolytic and nonhemolytic transfusion reactions.
  • List the antibodies associated with hemolytic transfusion reactions.
  • List the steps and procedures to follow in a laboratory investigation of a transfusion reaction.
  • List the steps and procedures to follow in a laboratory investigation of a transfusion reaction.
  • List the steps and procedures to follow in a laboratory investigation of a transfusion reaction.

Course Outline

  • Adverse Effects of Blood Transfusions
    • Transfusion Reactions: Introduction
  • Blood Component Transfusion Risks
    • Risks Associated with Transfusion
    • Categories of Transfusion Reactions
    • Transfusion Reactions Associated with Blood Products
  • Immediate Immunologic Transfusion Reactions
    • In Vivo Red Cell Destruction
  • Immune Hemolysis
    • Causes of Immune Hemolysis
    • Clinical Signs and Symptoms
    • Initial Transfusion Reaction Investigation
    • Additional Testing
    • Management and Prevention
    • An acute hemolytic transfusion reaction (AHTR) may be caused by which of the following?
  • Febrile Transfusion Reactions
    • Febrile Nonhemolytic Transfusion Reactions: Definition, Manifestation, and Prevalence
    • True or False: Leukocyte-reduced blood components are associated with the development of febrile nonhemolytic transfusion reactions (FNHTR).
    • A febrile nonhemolytic transfusion reaction (FNHTR) is characterized by which of the following symptoms?
  • Allergic Transfusion Reaction
    • Definition, Manifestations, and Prevalence of Allergic Reactions Related to Transfusion
    • Diagnosis, Treatment, and Prevention
    • True or False: Premedication with antihistamines may prevent an allergic reaction in patients with a history of multiple urticarial transfusion reactions.
  • Transfusion-Related Acute Lung Injury (TRALI)
    • Definition and Epidemiology
    • Clinical Presentation and Laboratory Findings
    • Pathophysiology
    • Diagnosis, Treatment, and Prognosis
    • Prevention of Transfusion-Related Acute Lung Injury (TRALI)
    • Which type of antibodies are known to cause transfusion-related acute lung injury (TRALI) reactions?
  • Acute Nonimmunologic Transfusion Reactions
    • Bacterial Contamination
      • Presentation and Prevalence of Bacterial Contamination
      • Sources of Contamination
      • Reducing Transfusion-Associated Septic Reactions
      • Which type of blood component is most often implicated in bacterial contamination?
    • Circulatory Overload
      • Transfusion-Associated Circulatory Overload (TACO)
      • True or False: Evaluating B-type natriuretic peptide (BNP) levels can be helpful in distinguishing transfusion-related acute lung injuries (TRALI) from transfusion-associated circulatory overload (TACO).
    • Physical/Chemical Hemolysis
      • Acute Pain and Hypotensive Reactions
    • Summary of Additional Testing in Acute (Immediate) Transfusion Reaction Investigations
      • Table: Additional Testing That May Be Ordered for Acute (Immediate) Transfusion Reaction Investigations
    • Delayed Immunologic Transfusion Reactions
      • Delayed Transfusion Reactions
        • Delayed Transfusion Reactions
        • DHTR: Diagnosis
        • Severe DHTR and Sickle Cell Anemia
        • True or False: Delayed hemolytic transfusion reactions (DHTR) typically occur 3 hours after transfusion.
      • Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)
        • Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD): Definition and Incidence
        • Clinical Presentation and Diagnosis
        • Therapy and Prevention
      • Post-Transfusion Purpura (PTP)
        • Definition/Manifestation/Prevalence
        • Pathophysiology, Treatment, and Prevention of Post-Transfusion Purpura (PTP)
        • Which of the following patients are not at risk for transfusion-associated graft versus host disease (TA-GVHD) and would not require cellular components prepared by a method known to prevent the disease?
        • Post-transfusion purpura (PTP) is characterized by all of the following except:
      • Delayed Non-Immunologic Transfusion Reactions
        • Iron Overload
        • Disease Transmission
        • True or False: Patients with diseases that require chronic transfusions are at risk for iron overload.
      • Investigation of a Delayed Transfusion Reaction
        • Investigation of a Delayed Transfusion Reaction
      • Reporting Transfusion Reactions
        • Recording and Reporting Transfusion Reactions
        • CDC Classification System for Surveillance of Transfusion Outcomes
      • References
        • References

Additional Information

Level of instruction: Intermediate
Intended audience: Medical laboratory scientists, medical technologists, and technicians. This course is also appropriate for clinical laboratory science students and pathology residents.
Author information: Erin Tretter, MBA, MT(ASCP) is the Division Manager of the Rapid Response Laboratory at Bryn Mawr Hospital in Bryn Mawr, Pennsylvania. Prior to taking this position, she was the Blood Bank Clinical Instructor for the Clinical Laboratory Science Program at St. Christopher’s Hospital for Children in Philadelphia and the Community College of Philadelphia. She has seven years’ experience teaching immunohematology concepts and laboratory procedures to Medical Technology students. She has also provided blood bank training to laboratory technologists and medical students. Erin holds a BS in Medical Technology from California University of Pennsylvania and Masters in Business Administration from Florida Institute of Technology.
Reviewer information:
Joshua J. Cannon, MS, MLS(ASCP)CMSHCM received his Bachelor of Science and Master of Science in Medical Laboratory Science from Thomas Jefferson University in Philadelphia, PA. He holds Medical Laboratory Scientist and Specialist in Hematology certifications through the ASCP Board of Certification. He was a professor at Thomas Jefferson University for seven years before transitioning into his current role as Education Developer at MediaLab. His areas of expertise and professional passions include clinical hematology and interprofessional education.
Barbara Cebulski, MS, MLS(ASCP) has over 40 years of experience in the medical laboratory profession as a technologist, section supervisor, and laboratory manager. She was an Inspection and Technical Specialist for nine years with the College of American Pathologists in the Laboratory Accreditation Program and, until her retirement in 2015, was Program Director for MediaLab, Inc. Barbara holds a Masters in Instructional Technology from Georgia State University.
Course information: This course is a review of clinical and laboratory recognition of transfusion reactions and the responsibilities of both areas for prevention of and proper response to a suspected reaction.