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Objectives:
Reference:
Contamination of Platelets
Platelet transfusion from multiple pooled donor platelets has greater risk of
infection compared to platelet unit from single donor
Related to bacterial overgrowth with time, shorter shelf life compared to red cells
Most commonly implicated are Staph. aureus, Klebsiella pnemoniae, Serratia
marcescens, and Staph. epidermidis
Transfusion-Mediated Immunomodulation
Immunosuppressive effect of blood transfusion is related to exposure to
leukocytes in donor blood
Clinically important in patients undergoing renal transplantation and in women
with multiple miscarriages
Immunosuppressive effects of blood transfusion remains controversial
Major Immunologic Reactions
Immunologic blood transfusion reactions results from interactions between
antibodies (inherited or acquired) with antigens associated with transfused blood
products
Initial symptoms of reactions with serious or benign consequences are often
similar
Anaphylactic Reactions
It is a life-threatening
It occurs within a few seconds to a few minutes after the start of a transfusion
Manifested by hypotension, angioedema, respiratory distress and shock
It is due to the presence of class-specific IgG, anti-IgA antibodies in patients who
are IgA deficient. Selective IgA deficiency is not uncommon, occurring in about 1
in 300 to 500 people. Fortunately, not all IgA deficient patients have developed
antibodies.
Management includes stopping the transfusion, Epinephrine, 0.3 IM
intramuscularly, possibly intravenous epinephrine drip, maintenance of airway,
and volume resuscitation and vasopressors if needed
It is important to make the diagnosis so that the next time patient receives
transfusion, it is either IgA-deficient blood products or extra-washed red cells or
platelet products
Post-transfusion purpura
Primarily seen in women
It occurs 5 to 10 days following transfusion
Manifested by severe thrombocytopenia, lasting days to weeks
It may be confused with drug-induced or idiopathic thrombocytopenic purpura,
since the blood and bone marrow smears are appear the same.
Preferred therapy is intravenous immune globulin (IVIG) since onset of action is
faster; other alternatives include high dose steroids or exchange transfusion,
although they can take weeks to work
CASE:
You are called to admit a patient with GIB in the ER and gather the following
information:
HPI: 56 yom with long history of alcoholism and multiple past admissions for alcohol
withdrawal presents to the ER complaining of nausea, vomiting and shakiness. Patient
states that he has been drinking 12 to 24 pack of beer each day for the past week and
started getting sick yesterday when vomiting started. Upon further questioning, he reveals
that he has been vomiting blood since this morning and started feeling quite dizzy. He
also describes his stool as being black for the past week. He also admits to having one
previous similar episode about 6 months ago and was admitted at another hospital. He
recalls having an upper scope, and that he had to be banded at areas where he was
bleeding.
You glance at the vitals while you are talking with the patient and observe the following:
Temp 37.6, rr 18, hr 120, b/p 90/60, O2 sat 93% RA
You note the ER Course next: patient is receiving 1 liter bolus of normal saline and
blood transfusion is started. Patient has refused NG lavage, but did vomit 100cc of red
blood while in the ER. While you are evaluating this patient for admission, the tech
comes by to take the temperature and notes a fever of 38.7 and patient complains of
dyspnea. What is your next step in management?
Review Questions:
A. Angina
B. Aortic regurgitation
C. Active bacterial infection
D. Age older than 60 years
3. Which of the following patients absolutely requires platelet transfusion?
A. A patient who has been taking aspirin for a headache and who is now scheduled
for emergent evacuation of his subdural hemorrhage; platelet count, 100,000
B. A patient with idiopathic thrombocytopenia; platelet count, 10,000
C. A patient with thrombotic thrombocytopenic purpura; platelet count, 9,000
D. A patient with end-stage liver disease who is complaining of easy bruising;
platelet count, 50,000
What is the first step in the diagnosis and management of this transfusion reaction?
1) Topic of module:__________________________
2) On a scale of 1-5, how effective was this module for learning this topic? _________
(1= not effective at all, 5 = extremely effective)
3) Were there any obvious errors, confusing data, or omissions? Please list/comment
below:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4) Was the attending involved in the teaching of this module? Yes/no (please circle).
5) Please provide any further comments/feedback about this module, or the inpatient
curriculum in general: