Immunopathology
Constantin A. Bona, Francisco A. Bonilla in Textbook of Immunology, 2019
Type II reactions are important in Coombs’ positive hemolytic anemia (see Chapter 4 for a description of the Coombs’ test). Red blood cells possess many different surface antigens, over 400 have been identified to date. Some are shared with many body tissues, some are erythrocyte-specific. The ABO group of polysaccharide antigens is one of the most well-studied. Approximately six months after birth, antibodies reacting with ABO antigens not found in the body begin to appear in the blood. These antibodies are called naturally occurring isohemagglutinins (antibodies agglutinating red blood cells). The antigens stimulating isohemagglutinin production are unknown, but they may be components of normal enteric flora which cross-react with ABO antigens. If blood is administered to a person with isohemagglutinins specific for ABO antigens in the transfused blood, a transfusion reaction ensues. Isohemagglutinins coat the foreign red cells which are then susceptible to complement lysis, opsonization and phagocytosis. The destruction of transfused cells combined with widespread activation of the complement and kinin systems may be fatal. Signs and symptoms of the transfusion reaction include fever, chills, hypotension, nausea, vomiting, hemoglobinemia, hemoglobinuria, and renal failure.
The patient with acute cardiovascular problems
Ian Peate, Helen Dutton in Acute Nursing Care, 2014
Transfusion of blood can be a life-saving procedure, however everyone’s blood is different and transfusing blood that is incompatible with the recipient’s can be fatal. The hazards of transfusion not only relate to incompatibility, blood is a complex liquid tissue and transfusion also carries the risk of: reactions to bacterially contaminated blood;transfusion-related acute lung injury (TRALI);acute fluid overload;severe allergic reaction or anaphylaxis. Thankfully serious or life-threatening acute reactions are rare, however any new symptoms or signs appearing whilst a patient is being transfused must be reported, they could be the first warnings of a serious reaction. It can be difficult to determine the type of reaction in the early stages so all those receiving a blood transfusion are monitored carefully and observations of vital signs are recorded frequently according to local protocols (usually every 30 minutes). Symptoms of transfusion reactions and appropriate actions are detailed in Figure 6.14.
Hyperthermia in oncology and nontoxic integrative treatments
Clifford L. K. Pang, Kaiman Lee in Hyperthermia in Oncology, 2015
After reinfusion, patients may show fevers of less than 38.5°C within 1 to 2 hours, with or without chills. There are many reasons for fevers caused by cell therapy, such as infectious pyrogens (e.g., bacteria and endotoxins) and immunologic factors (such as residual cytokines, cytokines released by immune response, and mediators of inflammation). The clinical treatment is done in the same way for the transfusion reaction. If the body temperature of the patient does not exceed 39°C, physical cooling can be applied. However, if the body temperature exceeds 39°C, the fever lasts for over 6 hours, or the patient feels any obvious discomfort, the stored cell samples must be delivered for inspection to rule out any infection, and it must be treated as an acute infection if it is indeed an infection.
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].
Coagulation in chronic liver disease and the use of prothrombin complex concentrate for an emergent procedure: a case report and review of literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Matthew Laubham, Eric Kallwitz
A final consideration is the routine correction of coagulopathy may have adverse effects. Transfusions may lead to worsening portal hypertension, which is a major contributor to bleeding events in cirrhotic patients. The risk of esophageal and gastric variceal bleeding increases with rising portal pressures. Varices are present in up to 30–40% of compensated cirrhosis at the time of diagnosis, and are present in 85% of Child–Pugh C patients [23,24]. Variceal bleeding in cirrhosis carries a mortality of 7–15% [25]. The use of fresh frozen plasma (FFP) in patients with cirrhosis and portal hypertension has been shown to increase portal pressures in a linear fashion based upon volume [26]. A study by Youssef points out that increased doses of FFP are often required to improve coagulopathy in chronic liver disease patients who were unresponsive to vitamin K therapy, highlighting that six units were associated with greater correction than compared to those receiving less than six units – a significant amount of volume [27]. Another risk and complication of transfusions are transfusion reactions, including transfusion-associated cardiac overload, allergic reactions and febrile transfusion reactions. A study evaluating transfusions in upper gastrointestinal bleeding found a higher rate of transfusion reactions and cardiac overload in the group with unrestricted transfusion [28].
Cutaneous-hemolytic loxoscelism following brown recluse spider envenomation: new understandings
Published in Clinical Toxicology, 2020
Justin K. Loden, Donna L. Seger, Henry A. Spiller, Li Wang, Daniel W. Byrne
Clinical effects and laboratory findings of all patients are summarized in Table 2. All comparisons were statistically significant. All hemolysis patients had spherocytes on peripheral blood smear. Patients with rhabdomyolysis had a median CPK of 1214 (IQR: 478–2325, mean: 2147, SD: 2441); three patients were positive for myoglobinuria but had no CPK evaluated. Seven patients with elevated creatinine had concomitant rhabdomyolysis. All patients with elevated transaminases had concomitant rhabdomyolysis. Hyperkalemia (n = 4), INR ≥2.0 (n = 3), acidosis that required bicarbonate administration (n = 3), and hypotension that required vasopressor support (n = 3) occurred only in patients with profound hemolytic anemia (hemoglobin <4 g/dL). These four patients developed severe anemic hypoxia requiring intubation, one suffered cardiogenic pulmonary edema (global hypokinesis; ejection fraction 40%; peak troponin 4.35 ng/mL). A fifth patient refused blood transfusion for religious reasons and subsequently developed profound anemia, but more information was unavailable as she transferred to another hospital. A sixth patient died of fulminant hemolysis the day of envenomation; her case is discussed elsewhere [27]. Interventions performed on hemolysis patients are provided in Table 3. The most common was blood transfusion (76.9%). The median dose of packed RBCs was 4.5 units (IQR: 4.0–7.0, mean: 4.0, SD: 2.4).
Related Knowledge Centers
- Coagulation
- White Blood Cell
- Platelet
- Circulatory System
- Hemoglobin
- Red Blood Cell
- Blood Plasma
- Blood Product
- Intravenous Therapy
- Whole Blood