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PubMedDate not supplied

Transfusion reactions: the changing priorities.

Over the last dozen years the relative frequencies of specific transfusion reactions have markedly altered, in general for the better. Although AIDS remains the Public's primary concern, the risk of AIDS from a transfusion is extremely low at this point. Hepatitis remains the most common infectious complication of blood transfusion, but only 1 in 6,000 units now carry a risk, whereas in the early 1980's the risk is believed to have been close to 10% per patient. Transmission of HTLV-I/II has also been markedly reduced by tests of donor sera. In contrast, cytomegalovirus has become of increased importance in view of the large number of patients immunosuppressed for transplantation and cancer therapy; bacterial growth in blood components appears to be increasingly common; and Chagas disease is likely to become a serious transfusion problem in this country. More widespread use of filters which remove three logs or more of white blood cells from components should play a major role in reducing transfusion reactions further.

Bacterial Infections↗
PubMed1993

Prevalence of platelet transfusion reactions before and after implementation of leukocyte-depleted platelet concentrates by filtration.

To determine the impact of platelet leukodepletion by filtration on the overall prevalence of reported transfusion reactions associated with platelet concentrates, we audited platelet transfusion reactions after infusion of platelet concentrates reported at University Hospitals of Cleveland over 6 months before (interval 1, July 1, 1989 to December 31, 1989) and after (interval 2, July 1, 1990 to December 31, 1990) implementation of the Pall PL 50 filter on our adult Hematology-Oncology inpatient unit (Division 60). Thirty-two (1.7%) of 1,901 random, pooled platelet transfusion events resulted in blood bank transfusion reaction workups in interval 1, compared to 90 (5.3%) of 1,704 in interval 2 (p < 0.001). The Division 60 service accounted for more of our hospital-wide platelet reactions after implementation of the filter in interval 2 (84%) than before filtration in interval 1 (42%), p = 0.002. The prevalence of reaction workups for Division 60 was 0.6% for interval 1, compared to 4.3% for interval 2 (p < 0.001). No differences were found between interval 1 and interval 2 for the rate of discontinuation of platelet transfusion (36 vs. 32%, p = 0.14), rate of premedication for platelet transfusion (72 vs. 65%, p = 0.6), percentage of direct antiglobulin test-positive reactions (17 vs. 5.4%, p = 0.09), percentage showing icteric/hemolyzed serum (15 vs. 4.4%, p = 0.09), or reactions believed to be due to red blood cell incompatibility (8.8 vs. 1.1%, p = 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

ABO Blood-Group System↗
PubMed2005

Hemolysis during percutaneous mechanical thrombectomy can mimic a hemolytic transfusion reaction.

BACKGROUND: Interventional radiologists have developed percutaneous mechanical thrombectomy (PMT) devices to remove intravascular thrombi. Hemolysis, secondary to thrombus destruction from these devices, has been described in radiology journals, but similar reports appear to be lacking in the transfusion medicine literature. Two cases of hemolysis after PMT are described that involved the transfusion service, one of which was reported as a hemolytic transfusion reaction. CASE REPORTS: The first patient received 4 units of red cells (RBCs) during a thrombectomy and subsequent placement of a transjugular intrahepatic portosystemic shunt. The patient developed hemoglobinuria, and it was reported to the blood bank as a possible hemolytic transfusion reaction. After RBC mismatch and bacterial contamination were excluded, the hemolysis was attributed to thrombectomy-related mechanical hemolysis. In the second case, a hemolyzed sample was sent to the blood bank for a type and cross-match. Upon requesting that the sample be redrawn, it was learned that the sample was obtained after PMT. CONCLUSION: Patients who have undergone PMT can have clinical and laboratory findings suggestive of hemolytic transfusion reactions. Although interventional radiologists are familiar with these side effects, the blood bank profession needs to be aware that these procedures cause nonimmune hemolysis and must consider this possibility when evaluating transfusion reactions in these patients.

Aged↗
PubMed1995

An acute hemolytic transfusion reaction caused by dog erythrocyte antigen 1.1 incompatibility in a previously sensitized dog.

An acute hemolytic transfusion reaction resulting from dog erythrocyte antigen (DEA) 1.1 incompatibility developed in a dog previously sensitized to DEA 1.1 by a transfusion 3 years earlier. The dog developed fever, pigmenturia, and lethargy, and its PCV did not rise as expected. The donor blood was type DEA 1.1 positive, whereas the recipient's blood was type DEA 1.1, DEA 1.2, and DEA 7 negative. A major crossmatch was later found to be strongly incompatible. Studies of the recipient's plasma revealed a specific anti-DEA 1.1 alloantibody of the IgG class with high hemolysin and agglutinin activity. Such acute hemolytic transfusion reactions can be avoided by crossmatching previously transfused dogs and by using dogs that are type DEA 1.1 negative (and preferably also type DEA 1.2 and DEA 7 negative) as blood donors.

Acute Disease↗
PubMed1990

[Compatibility problems in transfusion. Special reference to the delayed hemolytic transfusion reaction].

During 1988, our laboratory (The National Blood Group Reference Laboratory) detected clinically significant alloantibodies (excluding anti-D and anti-C + D) in samples from 72 patients from 24 different hospitals, transfusing about 40,000 units of red cells in this period of time. The simultaneous presence of autoantibodies complicated the serological diagnosis in a number of cases. Two patients had suffered acute haemolytic transfusion reactions due to antibodies not being discovered in the pretransfusion testing (anti-c and anti-Fya). 13 showed serological evidence of delayed haemolytic transfusion reaction not noted in the local hospital. We believe that delayed haemolytic transfusion reaction is seldom recognized. We stress the importance of quality control programmes in blood group serology.

Autoantibodies↗
PubMed2002

Anaphylactic transfusion reactions in haptoglobin-deficient patients with IgE and IgG haptoglobin antibodies.

BACKGROUND: Patients with haptoglobin deficiency associated with haptoglobin IgG antibodies, who experienced severe nonhemolytic transfusion reactions (NHTRs), have been identified in Japan. Haptoglobin deficiency therefore might be a risk factor for NHTRs. STUDY DESIGN AND METHODS: A total of 4138 cases of voluntarily reported NHTRs in Japan, including 367 cases of immediate-onset anaphylactic NHTRs, were examined to identify haptoglobin deficiency. Serum haptoglobin IgG and IgE antibodies were determined in haptoglobin-deficient patients to elucidate the mechanism underlying the transfusion reactions. RESULTS: Seven patients with haptoglobin deficiency were identified. Six of them experienced severe and acute NHTRs. Six of them were identified to be homozygous for the Hpdel allele of the haptoglobin gene. Both haptoglobin IgG and IgE antibodies were detected in serum samples of all the patients. The stimulative effects of blood transfusion on the production of hap- toglobin antibodies in the patients and the relation- ship between the presence of the antibodies and the occurrence of the transfusion reactions were observed. CONCLUSION: Anaphylactic NHTRs in these patients with haptoglobin deficiency associated with serum haptoglobin antibodies were suggested to be prevalent in Japan. In addition to IgG antibodies, IgE haptoglobin antibodies detected in the sera of such patients were suggested to play a role in the occurrence of the reactions.

Adolescent↗
PubMed1988

Risk of alloimmunization and delayed hemolytic transfusion reactions in patients with sickle cell disease.

Blood transfusion is an integral part of the supportive care of patients with sickle cell diseases. The hazards of red blood cell alloimmunization and delayed hemolytic transfusion reactions (DHTRs) complicate the treatment of patients with sickle cell diseases, particularly since such reactions may be misinterpreted as a pain crisis, and, as a result, specific transfusion serologic studies may not be performed. The frequency of alloimmunization in this population has been the subject of several reports; however, the frequency of DHTRs is unknown. To determine the frequency of this event, we retrospectively reviewed the medical and transfusion service records of all adult patients with sickle cell diseases transfused during the six-year period from January 1980 to December 1985. Seventy-three adult patients with sickle cell diseases received transfusions. The prevalence of recognized DHTR was three (4%) of 73. Red blood cell alloimmunization was seen in 22 (30%) of 73 of the patients. The calculated risk of alloimmunization was 3.1% per unit of blood. These observations suggest that alloimmunization and clinically apparent DHTRs occur more frequently in patients with sickle cell diseases and support pretransfusion testing for at least Rh and Kell red blood cell antigens in patients who are at high risk of such events (patients who have formed an alloantibody or who are being enrolled in a transfusion program).

Adolescent↗
PubMedDate not supplied

Cytokines as intercellular signals in hemolytic transfusion reactions.

Recent clinical and experimental evidence indicates that many of the sequelae of hemolytic transfusion reactions may be mediated by cytokines, including interleukin-1 beta, interleukin-6, tumor necrosis factor-alpha, the chemokines interleukin-8 and monocyte chemoattractant protein-1, and interleukin-1 receptor antagonist. Experimental models of both acute and delayed hemolytic transfusion reactions demonstrate the production of these molecules. The time course and relative patterns of production correlate well with known clinical manifestations of these reactions. Tumor necrosis factor-alpha appears to be central to ABO incompatibility reactions, and stimulates endothelial cells to exhibit procoagulant activity and surface adhesion molecules.

ABO Blood-Group System↗
PubMed1982

Febrile transfusion reaction: what blood component should be given next?

Reports of febrile, nonhemolytic transfusion reactions (FNHTR) occurring at hospitals served by a regional blood center supplying 99,658 units of blood during 1980 were analyzed to determine if leukocyte-poor red blood cells prepared by the inverted centrifugation technique (LP RBCs) were adequate to prevent subsequent reactions. FNHTR occurred following 0.5% of units transfused. The records of transfusions given to patients who had a FNHTR were reviewed in a subgroup of hospitals. Of 253 such patients, 161 received subsequent transfusions, 140 received red cells or LP RBCs without a reaction. The remaining 21 had a second reaction following transfusion of packed red cells. 12 of the 21 received further red cell transfusions. Only one experienced a third febrile reaction after receiving LP RBCs. We conclude that LP RBCs are adequate to prevent recurrence of FNHTR and question the need for costly saline-washed, leukocyte-poor red blood cells for this purpose.

Blood Grouping and Crossmatching↗
PubMed1984

Hemolytic transfusion reactions in oncology patients: experience in a large cancer center.

At The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston, the incidence of hemolytic transfusion reactions over an eight-year period (1974-1981) was analyzed. Only four hemolytic transfusion reactions were reported out of 142,957 transfusions of blood (a frequency of one reaction in 35,739.25 transfusions). This could be due to the following factors: (1) Impairment of immune status related to the malignant process or temporary immunosuppression caused by intensive chemotherapy could enable patients to tolerate incompatible transfusions. (2) The reactions are overlooked or masked by the severity of disease in cancer patients in spite of an elaborate education for nurses, residents/fellows, and staff physicians about the dangers of hemolytic reactions. The figures herein reported are lower than those reported from non-oncology hospital settings.

Adult↗
PubMed1993

Anaphylactoid transfusion reaction with anti-IgA antibodies in an IgA deficient patient: a case report.

A case of anaphylactoid transfusion reaction associated with anti-IgA antibodies is reported. The patient had low levels of serum IgA. She developed serious reaction characterised by erythematous rash, pruritus, cyanosis and dyspnoea after transfusion of otherwise compatible blood. Review of literature reveals that anaphylactoid transfusion reactions are very rare although frequency of anti-IgA in general population is quite high. The IgA deficient donors (aIgA) form a unique resource of blood components for the clinical management of patients with anaphylactoid reactions caused by anti-IgA.

Adult↗
PubMed1991

[Report of a case with a delayed hemolytic transfusion reaction after open heart surgery].

A case of delayed hemolytic transfusion reaction (DHTR) caused by blood transfusions after open heart surgery was reported in a 61-year-old woman. She had undergone mitral annuloplasty 8 years before. She underwent the 2nd mitral and tricuspid annuloplasty for recurrent mitral and tricuspid regurgitation in 1988. After the reoperation, she developed severe hemolytic anemia with fever. The anti-Jka antibody was detected in her serum by the blood antibody screening test. She was diagnosed to have a DHTR. She was treated conservatively and recovered.

Anemia, Hemolytic↗
PubMed1990

The risk of an overt hemolytic transfusion reaction following the use of an immediate spin crossmatch.

The major crossmatch must include an anti-human globulin test, unless the transfusion recipient has no apparent significant unexpected antibodies, in which case the use of only an immediate spin crossmatch method is considered acceptable. However, a minority of laboratories utilize only an immediate spin crossmatch as their routine major crossmatch, possibly because contemporary antibody screening tests occasionally miss detecting some unexpected antibodies, and these missed antibodies are more often detected by the anti-human globulin crossmatch than by the immediate spin crossmatch. In the present study, 20 hospitals were surveyed to determine how often an acute hemolytic transfusion reaction would occur when only an immediate spin crossmatch was used as the major crossmatch method. During the study period, 1.3 million immediate spin crossmatches were performed, and five patients experienced acute overt hemolytic transfusion reactions that were believed to be caused by antibodies that were missed by both the antibody screening test and immediate spin crossmatch (one hemolytic event per 250,000 immediate spin crossmatches). The implicated antibodies were anti-Jka, anti-Wra, anti-C, anti-c, and anti-Kpa. These survey data demonstrate that the routine crossmatching of blood using an immediate spin crossmatch may rarely result in an acute hemolytic transfusion reaction if the antibody screening cells used during pretransfusion compatibility testing fail to detect some clinically significant red blood cell antibodies.

Blood Group Incompatibility↗
PubMedDate not supplied

Delayed overt hemolytic transfusion reaction due to anti-U antibody.

A patient is described who developed a delayed hemolytic transfusion reaction, 11 days posttransfusion, caused by anti-U. This case illustrates the difficulty that can occur in distinguishing a delayed transfusion reaction from autoimmune hemolytic disease when the antibody involved is directed against a high incidence blood group antigen.

Adult↗
PubMed2004

Hypotensive transfusion reactions can occur with blood products that are leukoreduced before storage.

BACKGROUND: Leukoreduction before storage, rather than bedside white blood cell filtration, is recommended to prevent hypotensive transfusion reactions. STUDY DESIGN AND METHODS: Investigation of hypotensive transfusion reactions during radical prostatectomy in two patients on angiotensin-converting enzyme inhibitors. In Patient A, hypotension occurred during the transfusion of each of the following blood products: 2 units of autologous blood deposited and leukoreduced (LR) before storage; 3 units of allogeneic red cells LR before storage; and 2 units of non-LR acute normovolemic hemodilution (ANH) whole blood. When each of the transfusions was stopped, the blood pressure recovered. In Patient B, hypotension occurred during the transfusion of non-LR ANH whole blood. All implicated units were administered rapidly using a blood infuser at 37 degrees C. Bradykinin (BK) and des-Arg9-BK formation and degradation and the activity of kinin-degrading metallopeptidases were measured in plasma samples from both patients. RESULTS: Degradation of des-Arg9-BK was severely impaired and the activity of aminopeptidase P severely reduced in Patient A, but not in Patient B. BK degradation was mildly impaired in both patients. CONCLUSION: Hypotensive reactions can occur with blood products that are LR before storage and non-LR ANH. An inherent defect in the metabolism of kinins may be a risk factor for the development of hypotensive transfusion reactions.

Adenocarcinoma↗
PubMed1967

Fatal transfusion reaction due to Serratia marcescens.

A fatal blood transfusion reaction due to contamination of the blood by Serratia marcescens is described. The diagnosis and treatment of such cases is described briefly. The importance of teamwork in all concerned with blood transfusion is stressed.

Adult↗