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At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Transfusion reaction. An immunologic hazard of blood transfusion.

Twenty-three cases of delayed hemolytic transfusion reaction (DHTR) occurring at the Mayo Clinic from 1964 through 1973 are reviewed. Nineteen patients had clinical manifestations of hemolysis, of which fever was the most frequent presenting symptom. The degree of hemolysis served as an index of morbidity. In four cases, there was oliguria, two of these patients experiencing renal shutdown. In one case, hemolysis led to a disseminated intravascular coagulation syndrome. Death occurred subsequent of DHTR in three patients. The direct antiglobulin test was positive in all but one case; this finding coincided with elevated unconjugated bilirubin in 14 cases and decreased haptoglobin levels in 15 cases. Anti-Jka antibody accounted for somewhat more than one-third of reactions and, along with anti-E, c, D, Fya, and K antibodies accounted for 91 per cent of cases.

Adult↗
PubMedDate not supplied

The role of cytokines and adhesive molecules in febrile non-hemolytic transfusion reactions.

Febrile non-hemolytic transfusion reactions occur not infrequently following transfusion. Our understanding of the molecular biology of these reactions has increased dramatically over the past few years. A variety of biological response modifiers have been shown to play a role in these reactions. These chemical messengers include cytokines, complement fragments, antibodies and adhesion molecules. Many of the clinical symptoms associated with these reactions are attributable to activation and generation of these substances. This review article will cover the role of cytokines in generation of non-hemolytic febrile transfusion reactions and the role of activation of adhesion molecules in the generation of TRALI (non-cardiogenic pulmonary edema). Our ability to modulate the generation of these chemical messengers could help us control clinical symptoms associated with these transfusion reactions.

Cell Adhesion Molecules↗
PubMed2000

The utility of < or =3-day-old whole-blood platelets in reducing the incidence of febrile nonhemolytic transfusion reactions.

BACKGROUND: Febrile nonhemolytic transfusion reactions (FNHTRs) to platelet transfusions have been linked to the presence of cytokines in supernatant plasma. Cytokine concentration is directly related to WBC content and storage time. This study evaluated the effect of limiting the storage time of random-donor platelet concentrates on the FNHTR rate. STUDY DESIGN AND METHODS: FNHTR rates were calculated retrospectively for single-donor apheresis platelet (SDP) and pooled random-donor platelet (PP) transfusions given during three consecutive 5-month study periods (November 1995 to February 1997) to patients on a single hematology/oncology/bone marrow transplant unit. Transfusion practice policies were: Baseline Period, SDPs preferred; Study Period A, PPs preferred; and Study Period B, < or =3-day-old PPs preferred. FNHTR rates were calculated from physicians' interpretations of reported reactions and the total number of SDP and PP transfusions in each period. SDPs were collected on two cell separators. All platelet components were filtered at issue in the laboratory by WBC-reduction filters. RESULTS: FNHTR rates for PP transfusions were: baseline, 11.1 percent (3/27); Study Period A, 4.6 percent (22/481); and Study Period B, 1.1 percent (3/282). The rates for SDP transfusions were 0. 15 percent (1/650), 0.75 percent (2/267), and 0.36 percent (1/273), respectively. The FNHTR rate for < or =3-day-old PPs was significantly less than the rate for older PPs (p = 0.0086 for Study Period A vs. Study Period B), and was not significantly different than that for SDPs (p = 0.33 for PPs vs. SDPs in Study Period B). CONCLUSION: Limiting transfusion of PPs to those stored </=3 days is an effective strategy in reducing the rate of FNHTR and results in an FNHTR rate comparable to that seen with SDPs.

Blood Platelets↗
PubMed1989

Influence of blood storage time and plasma histamine levels on the pattern of transfusion reactions.

The data from 359 transfusion reactions reported over a 3-year period have been compared with those obtained from 359 matched units given at the same time as the former but not implicated in a reaction. It was found that patients who developed reactions which were not accompanied by a change in body temperature received units with a longer storage time than patients experiencing febrile reactions. In addition it was noted that reactions which included a skin rash also tended to be associated with units stored for longer. In a further prospective assessment plasma histamine levels were measured in a group of 71 patients experiencing 'anaphylactoid', febrile and mixed transfusion reactions as well as in individuals in whom blood transfusions did not cause a reaction. The 'anaphylactoid' reaction group demonstrated a mean plasma histamine level in excess of 1 ng/ml, whereas mean concentrations below 0.50 ng/ml were recorded in the other 3 groups. Our data also suggested that in general, more and 'older' blood was given to the 'anaphylactoid' reactors. The high plasma histamine concentrations could readily contribute to the rash, wheeze and flushing recorded in these individuals. Thus, if a long shelf-life for stored blood is required, strategies which remove histamine from the unit may be worth considering.

Blood Preservation↗
PubMed2002

[Acute hemolytic transfusion reaction].

Alloogenous blood and/or corresponding haemoproduct transfusion is an efficient and relatively safe supportive treatment. Despite the fact that pre transfusion investigation of both patients and donors ensure high degree of safety of this type of treatment, occurrence of adverse haemotherapy effects is possible and often unpredictable. Acute haemolytic transfusion reaction occur as a consequence of immune conflict between red blood cell membrane agents and specific antibodies present in plasma. Since it is impossible to completely avoid the occurrence of transfusion reactions, wherein acute transfusion haemolytic reaction present a serious, possibly life threatening complication, it is an imperative to continue to improve the knowledge on pathogenesis mechanisms leading to complications associated with these reaction and to define the most efficient therapeutical modalities.

Acute Disease↗
PubMed1983

Transfusion reactions in cats due to AB blood group incompatibility.

Blood transfusion reactions were investigated in 70 unsensitised and sensitised cats. Twenty-five compatible transfusions with respect to the AB blood group system did not result in any immediate transfusion reactions. Transfusion of B erythrocytes in 12 group A cats did not produce any severe reactions because of low anti-B titres in the A recipients. However, 30 of 50 group B cats (60 per cent) suffered severe shock reactions, characterised by marked hypotension, cessation of respiration and sometimes atrio-ventricular blocks, within two minutes of the injection of incompatible A cells (phase 1). From 35 seconds to five minutes later, markedly elevated blood pressures and extrasystoles were recorded (phase 2). The blood pressures generally stabilised within 30 minutes. Haemoconcentration and leucopenia were observed in severely reacting cats and leucopenia was also recorded in some A cats who received incompatible cells but did not exhibit transfusion reactions.

ABO Blood-Group System↗
PubMed1997

Relationship of the time of storage and transfusion reactions to platelet concentrates from buffy coats.

BACKGROUND: Transfusion reactions to platelet concentrates prepared from buffy coats (BC-PCs) were reviewed to determine the effect of some variables of BC-PC preparation and storage: time of BC storage before BC-PC preparation (1-2 days); time of BC-PC storage before transfusion (1-5 days); no white cell reduction versus laboratory and bedside BC-PC white cell reduction. STUDY DESIGN AND METHODS: A multiple linear logistic regression model was used by which the relative effect of one variable is expressed as the relative risk of transfusion reaction against a baseline level (1-day storage, no white cell reduction). RESULTS: During the 14 months of study, a total of 2707 BC-PC transfusions were given to 192 patients; 37 reactions (1.4%) were reported in 25 patients (13%). The transfusion reactions were febrile, nonhemolytic in 23 cases; allergic in 5; febrile and allergic in 2; and other in 7. The relative risk of transfusion reaction to BC-PCs prepared from BCs stored for 2 days was 1.98 times that to BC-PCs prepared from BCs stored for 1 day (p = 0.07). The relative risk of transfusion reaction of 5-day-old BC-PCs was 10.7 times that of 1-day-old BC-PCs (p = 0.001). The relative risk of transfusion reactions of BC-PCs white cell-reduced in the laboratory and at the bedside were 0.65 (p = 0.3) and 1.87 (p = 0.1) times, respectively, that of non-white cell-reduced BC-PCs. CONCLUSION: Time of storage seems to be an important variable associated with BC-PC transfusion reaction.

Blood Component Transfusion↗
PubMed1988

Febrile transfusion reaction caused by AB0-incompatible platelet transfusion.

A febrile transfusion reaction caused by strong isoagglutinins in the patients serum is reported. The reaction resulted from a transfusion of group A platelets in a group 0 patient; the recipients' serum contained high titered isohemagglutinin (Anti-A 1:8192) capable of lysing bloodgroup A1 red cells up to a titer of 1:8. Moreover, the serum showed a strong positive thrombocytotoxic reaction with the platelets of the donor and some other group A individuals, but remained negative with group 0, and turned to negative reaction with group A samples after neutralization with bloodgroup substance. We conclude that pretransfusion testing of group 0 donors and recipients for isohemolysins combined with platelet crossmatching may prevent febrile reactions.

ABO Blood-Group System↗
PubMedDate not supplied

Delayed hemolytic transfusion reaction caused by a primary immune response.

Delayed hemolytic transfusion reactions usually occur as a result of a secondary immune response with maximal hemolysis occurring seven days posttransfusion. We report a delayed hemolytic transfusion reaction in which hemoglobinuria, anemia, and reticulocytosis developed four weeks after transfusion. The incriminated antibody, anti-C, was first detected eight weeks posttransfusion using enzyme-treated red blood cells. We conclude, that in all likelihood, this hemolytic transfusion reaction was due to a primary immune response, this case illustrates the importance of sequential testing in cases of suspected transfusion reactions.

Adult↗
PubMed1990

Acute transfusion reactions.

We reviewed 1500 acute transfusion reactions that were reported to the Auckland Regional Blood centre over a 7 year period, from approximately 440,000 transfusions. The majority of reactions were to red cells, and these had the highest reaction incidence per unit (0.73%) of all blood products. The reaction incidence per unit transfused for plasma was 0.1%, for stable plasma protein solution 0.01%, and for platelets 0.04%. The majority of symptoms reported were mild and transient. The commonest were fever (72%), rigors (33%), and rash or urticaria (30%). Although more serious reactions were reported such as angioedema, hypotension and pulmonary oedema, none of these were severe, as judged from the data reported to the centre. There were two transfusion related deaths during the study period, one due to an ABO incompatible transfusion, the other due to bacterial contamination of a unit of blood. Leucocyte agglutinins or antibodies were detected in 29% of those with a febrile reaction, but were also detected in 22% of those who remained afebrile. Serological abnormalities that may have accounted for the reaction were only detected in 12 patients six of whom had autoantibodies. As laboratory investigation reveals little that accurately defines the aetiology of a reaction, a rationalisation of the investigation into acute transfusion reactions is suggested.

ABO Blood-Group System↗
PubMed2002

Hemolytic transfusion reaction: safeguards for practice.

Most hemolytic transfusion reactions result from administration of ABO-incompatible blood. Even a small amount of incompatible blood may initiate a reaction and cause devastating consequences leading to death. Careful monitoring of the anesthetized patient is important in recognizing symptoms of a transfusion reaction so that the reaction may be promptly detected and treatment quickly initiated. Many factors contribute to blood transfusion errors resulting from the misidentification of either the patient or the blood product. Nursing has opportunities to establish policies and procedures, design nursing practices, and educate staff to help avoid blood transfusion errors.

Anemia, Hemolytic↗
PubMed2005

Pre-storage leucocyte depletion and transfusion reaction rates in cancer patients.

Passenger leucocytes transfused with allogenic blood are responsible for potential adverse effects. The impact of pre-storage leucodepletion (in-line filtration) of all whole blood units on transfusion reaction rate among patients suffering from cancer was retrospectively studied, comparing all reactions following red blood cell (RBC) transfusions during 2 years of pre-storage vs. 2 years of selective (bedside) leucodepletion. During selective leucodepletion, 5165 RBC units - of which 2745 were bedside filtered units- were transfused to 866 patients. Twenty-eight reactions were recorded: 22 (15 in the bedside group) febrile non-haemolytic transfusion reactions (FNHTR) and six allergic reactions (five in the bedside group). The overall percentage of reactions was 0.54 (0.76 for bedside) and 0.42 for FNHTR (0.54 for bedside). During pre-storage leucodepletion, 4116 RBC units were transfused to 841 patients. Eleven reactions were recorded: four FNHTR and seven allergic reactions (urticaria). The percentage of reactions for transfused RBC units was 0.26 (0.09 for FNHTR). Comparison between pre-storage filtration and bedside filtration with regard to FNHTR showed an odds ratio of 2.80 (95% confidence interval = 0.83-14.87) for bedside filtration. The study suggests that, for transfused patients affected by cancer, pre-storage leucodepletion is more effective than selective (bedside) filtration in reducing the incidence of transfusion reactions (FNHTR).

Adolescent↗
PubMed1982

Blood transfusion reactions in the cat.

The transfusion of only 4 ml of group A blood resulted in sudden death of a cat that was recovering from surgery. The clinical signs were similar in many respects to those exhibited by tranquilized group B cats when challenge exposed for the 1st time with incompatible A cells. The distribution of the A and B blood group antigens and the occurrence of naturally occurring isoantibodies in the cat were considered in relation to the probability of producing transfusion reactions. The results obtained with tranquilized and anesthetized cats demonstrated that immediate reactions can occur following the 1st transfusion of incompatible red blood cells. Cross matching with respect to the AB system is recommended before giving blood transfusions to cats.

ABO Blood-Group System↗
PubMed1980

Clinical presentation of nonhaemolytic transfusion reactions.

Due to the sophistication of red cell compatibility testing, the majority of transfusion reactions are non-haemolytic in origin. This paper reviews the clinical presentation of these reactions, emphasising that blood transfusion reaction must always be considered in the differential diagnosis when a patient develops unexpected complications during his hospital stay. Fever, allergic reactions, respiratory distress, hypotension and jaundice may all be manifestations of a transfusion reaction.

Fever↗
PubMed1985

The serology of febrile transfusion reactions.

Sera from 40 patients with febrile, nonhemolytic transfusion reactions were tested for the presence of alloantibodies using a number of techniques, including immuno-fluorescence tests on granulocytes, lymphocytes and platelets, a modified NIH lymphocytotoxicity test and the leukocyte agglutination test. Cells of at least 9 donors were used as target cells. Alloantibodies were detected in all sera. The frequency of the occurrence of antibodies was not much higher in sera obtained about 1 month after the transfusion reaction as in sera obtained within 4 days. Most of these antibodies were anti-HLA, but quite frequently platelet-specific antibodies were found, and sometimes these were the only antibodies detected. Granulocyte-specific antibodies were the least frequent. The nature of the antibodies was specified by their difference in reactivity with the cells of multiple donors, by applying panels of cells from typed donors and by absorption and elution experiments. It appeared that not only granulocyte-specific but also HLA- and perhaps platelet-specific antibodies may be responsible for a febrile transfusion reaction. We did not find that the occurrence of rigors, together with fever, was associated with particular serologic results.

Adult↗
PubMed2004

The effect of prestorage WBC reduction on the rates of febrile nonhemolytic transfusion reactions to platelet concentrates and RBC.

BACKGROUND: Febrile non-hemolytic transfusion reactions (FNHTRs) are a common complication of platelet concentrate (PC) and RBC transfusions, usually ascribed to cytokines released by WBCs and perhaps the platelets themselves during storage. Prestorage WBC reduction should abrogate the accumulation of these cytokines reducing the number of FNHTRs. STUDY DESIGN AND METHODS: A retrospective analysis of FNHTR to PCs and RBCs before universal WBC reduction (PrUR) (July 1997-January 1998 for PCs, July 1997-July 1999 for RBCs) and after its introduction (PoUR) (February 1998-August 2001 for PC, August 1999-August 2001 for RBCs) was undertaken. All transfusion reactions were stratified based on component and date of reaction. Other adverse transfusion reactions were grouped into three periods: July 1997-January 1998, February 1998-July 1999, and August 1999-August 2001. A chi-square test was performed to determine the significance of the differences between groups. RESULTS: In the PRUR group, there were: 231 FNHTRs in 70,396 RBC units transfused (0.33%) and 29 FNHTRs in 6502 PC units transfused (0.45% percent). In the PoUR group, there were 136 FNHTRs in 72,949 RBC units transfused (0.19%, p < 0.001) and 56 FNHTRs in 50,555 PC units transfused (0.11%, p < 0.001). Of the other adverse events, only TRALI reactions were significantly reduced. CONCLUSION: Prestorage WBC reduction significantly reduced the rate of FNHTRs to PCs and RBCs.

Blood Preservation↗
PubMed1996

Acute gram-negative urosepsis mimicking an acute hemolytic transfusion reaction.

BACKGROUND: The acute hemolytic transfusion reaction (AHTR) is one of the most feared complications of blood transfusion. Over the years, several clinical conditions, as well as errors in blood component preparation and administration, that mimic AHTR have been identified. This report describes a novel variation on the theme of pseudo-AHTR. CASE REPORT: A 47-year-old diabetic man with drug-induced pancytopenia suddenly manifested severe shaking chills, flank pain, and back pain during a red cell transfusion. The passage of bright red urine immediately after the transfusion virtually confirmed for the clinicians administering the transfusion that an AHTR had occurred. In the laboratory, the hematuria was shown to be due principally to red cells and not to free hemoglobin. Further posttransfusion work-up showed a urinary tract infection and overwhelming bacterial sepsis with Escherichia coli. CONCLUSION: As a pseudo-AHTR, gram-negative bacterial sepsis of urinary tract origin may surpass other forms of sepsis. Urosepsis should be considered in the work-up of a suspected AHTR in a pancytopenic patient with a urinary tract infection.

Acute Disease↗