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A tired old lady
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Major transfusion reactions are rare. However, monitor the patient for pain, fever, flushing, rash, shortness of breath, wheeze, vomiting or hypotension. If any symptoms occur, the transfusion should be stopped and appropriate management commenced.
Sickle cell disease
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Marc R. Parrish, John C. Morrison
Obviously, most of the complications associated with this approach are related to the risk of the blood products. Blood products given to these patients should be from cytomegalo-virus-seronegative donors or leukoreduced. Careful cross-matching to minimize minor blood incompatibilities and alloimmunization is critical in avoiding problems later for these patients who may need blood products at various points during their life. The use of blood from family members or friends matched for recipient and donor red cell antigens are clinically helpful in reducing the number of post-transfusion crises. Such episodes are known as delayed hemolytic transfusion reactions. The exact mechanism of hemolytic transfusion reaction is not well understood, and the pathophysiology seems to be far more complex because it involves the destruction of both patient and donor RBCs. A subcategory of this problem is known as a delayed transfusion reaction. It is classically characterized by a clinical triad of fever, hyperbilirubinemia, and anemia occurring 3–10 days after transfusion. Laboratory tests that aid diagnosis include increased reticulocyte count, free hemoglobin in the urine, fragmented RBCs on peripheral smear, decreased post-transfusion Hb A on electrophoresis, or discovery of previously undetected alloantibodies (47).
Blood transfusion
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Ensure that you are aware of the different types of transfusion reaction, as the management varies. This will range from simply slowing the rate of transfusion to treating shocked patients with blood group incompatibility.
Adverse transfusion reactions and what we can do
Published in Expert Review of Hematology, 2022
Yajie Wang, Quan Rao, Xiaofei Li
Transfusions of blood and blood components are generally safe but have natural risks. There are usually two different aspects. One is alloimmunization, the other is other immunological and inflammatory reactions [196]. In this review, we summarize the commonly encountered transfusion reactions from the aspects of mechanism, clinical characteristics and management. When an acute transfusion reaction is suspected, timely identification and immediate cessation are critical. As signs and symptoms (eg, fever, chills and dyspnea) are often overlapping and nonspecific, it is required to distinguish delayed responses or reactions. It is essential to diagnose correctly and provide appropriate treatments for ensuring the safety of any future transfusions. Various literatures have provided detailed guidance on this, which can be used as a reference for clinical staff [63,197,198]. The incidence of many transfusion-related adverse events is decreasing, but threats to transfusion safety are always emerging. Prevention requires strict adherence to blood transfusion indications, administration policies of restrictive blood transfusion, and avoidance of unnecessary blood transfusions. Many of the evidence-based recommendations need more verification in patients with the diverse risk factors. Newer donor policies and blood screening methods, new assay method, and electronic verification systems can decrease the incidence of serious transfusion reactions. It is also very important to report any suspicious reactions to the blood bank to facilitate further investigation of the cause and avoid similar adverse reactions in the future [199].
Advances in single-cell nanoencapsulation and applications in diseases
Published in Journal of Microencapsulation, 2022
Ziyang Xue, Dan Mei, Lingling Zhang
Kroshus et al. found that the mechanism by which xenogeneic RBCs induce immune rejection after transfusion into humans is the same as the incompatibility of RBC types in human allogeneic blood transfusion (Kroshus et al.1995). There are three main immune reactions: intravascular haemolytic reaction, extravascular haemolytic reaction and delayed haemolytic transfusion reaction. Intravascular haemolysis refers to the specific binding of xenogeneic RBCs to antibodies in human serum and activates the cascade amplification effect of the entire complement system. RBCs are quickly destroyed, and haemoglobin is released into the blood. The immune rejection reaction occurs very quickly and strongly, and human IgG antibodies play a principal role in the reaction process. Extravascular haemolysis mainly refers to the haemolytic reaction caused by the destruction of xenogeneic RBCs in the spleen by macrophages. This immune response occurs relatively slowly and moderately, usually due to the low number of IgG associated with xenogeneic RBCs, which is insufficient to activate the entire complement system cascade amplification reaction. The delayed haemolytic transfusion reaction is mainly due to the presence of antibodies in the body of the recipient who has been immunised due to blood transfusion or pregnancy.
Blood product administration during high risk neuroblastoma therapy
Published in Pediatric Hematology and Oncology, 2020
Allison Silverstein, Kiranmye Reddy, Valeria Smith, Jennifer H. Foster, Heidi V. Russell, Sarah B. Whittle
These results show that as therapy has intensified over time, so too have exposures to blood products. Blood product transfusions carry several medical and non-medical risks. Increases in transfusion requirements likely lead to additional or longer clinic visits, hospitalizations, and emergency room visits, all of which contribute to the burden of diagnosis to a family including time away from work, school and home, and costs to both the family and medical system. Medical risks of transfusion include acute risks such as transfusion reactions, viral and bacterial infections, and chronic risks including immune injury and modulation and transfusional iron overload.9,17–19 While little is known regarding long-term effects from platelet transfusions, repeated red blood cell transfusions are known to cause iron overload.9,18