Blood transfusion is a relatively common OSCE station. It is essential that you practice the various compulsory steps required to safely administer a blood transfusion. This blood transfusion OSCE guide provides a systematic approach to safely arranging and administering a blood transfusion.
Anti-A/B antibodies activate the complement pathway and the release of inflammatory cytokines.
Early signs are fever, hypotension, anxiety, and red-coloured urine.
Late signs are generalised bleeding, caused by disseminated intravascular coagulation, and hypotension.
Transfusion related acute lung injury (TRALI)
Pathophysiology not fully understood but antibodies to human neutrophils antigens and human leukocyte antigens have been implicated.
The typical presentation of TRALI is the sudden development of dyspnea, severe hypoxemia (O2 saturation <90% in room air), hypotension, and fever that develop within 6 hours after transfusion and usually resolve with supportive care within 48 to 96 hours.
Occurs because recipient is allergic to protein components in donor transfusion
Typically causes more than one of the following: an itchy rash, throat or tongue swelling (angioedema), shortness of breath, vomiting, lightheadedness, and low blood pressure.
The symptoms typically come on over minutes to hours and can result in death
Each unit of blood is equivalent to 450 ml of fluid and therefore may cause fluid overload if the patient has multiple transfusions.
Those most at risk include the elderly and particularly those with congestive cardiac failure
Delayed haemolytic reaction
Antibodies to minor antigens such as Rhesus or Kidd
A haemolytic reaction can occur between 3 and 14 days as a result of a secondary immune response, with a drop in haemoglobin level, fever, jaundice, or haemoglobinuria.
Associated with fever but not directly with haemolysis.
It is most commonly caused by antibodies directed against donor leukocytes and HLA antigens. This is in contrast to transfusion-associated acute lung injury, in which the donor plasma has antibodies directed against the recipient HLA antigens, mediating the characteristic lung damage
Mainly occurs in multiply transfused patients or women with multiple previous pregnancies
Post-transfusion purpura (PTP)
An adverse reaction to a blood transfusion or platelet transfusion that occurs when the body produces alloantibodies to the introduced platelets’ antigens.
These alloantibodies destroy the patient’s platelets leading to thrombocytopenia, a rapid decline in platelet count.
PTP usually presents 5–12 days after transfusion, and is a potentially fatal condition.
Graft vs host disease (GvHD)
Graft-versus-host disease is a medical complication following the receipt of transplanted tissue from a genetically different person.
Immune cells (white blood cells) in the donated tissue (the graft) recognize the recipient (the host) as foreign (nonself). The transplanted immune cells then attack the host’s body cells.
GvHD can occur after a blood transfusion if the blood products used have not been irradiated or treated with an approved pathogen reduction system.
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