LAB 14- Transfusion Reaction Workup PDF

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Summary

Following this laboratory exercise, the student will be able to:
1. Perform a transfusion reaction workup.
2. Interpret the history, clinical symptoms, and workup to classify the transfusion reaction....

Description

LAB 14: Transfusion Reaction Workup OBJECTIVES Following this laboratory exercise, the student will be able to: 1. Perform a transfusion reaction workup. 2. Interpret the history, clinical symptoms, and workup to classify the transfusion reaction. PRINCIPLE / DISCUSSION Adverse reactions to transfusion often cannot be avoided. The most important part of investigating a reaction is to determine if a clerical error has occurred that could result in a fatal or serious consequence. The next issue to resolve is to determine if the patient possesses an antibody that was missed in pretransfusion testing or has increased in strength to a detectable level. A common finding in both of these circumstances is the hemolysis of red cells. The goal of a transfusion reaction investigation is to rule a hemolytic reaction in or out. Because clerical errors are the cause of a majority of immediate, fatal reactions, a complete check of all paperwork is the first step in any transfusion reaction workup. The patient’s symptoms will provide clues to the recognition of the three major categories of transfusion reactions: 1. Urticarial or allergic reactions: symptoms such as hives, itching, rash, or urticaria 2. Febrile reactions: symptoms such as a sudden spike in temperature (≥1º C) and chills 3. Hemolytic reactions: symptoms such as fever, chills, dyspnea, cyanosis, coughing, generalized aches and pains, pain at the transfusion site, rapid hypertension, headache, chest or back pain, vomiting, palpitation, or a feeling of impending doom Symptoms other than an allergic reaction require a complete transfusion reaction workup. In cases of allergic reactions, a paperwork check is all that is necessary. In cases of transfusion reactions, the instructions to the transfusing personnel include: 1. Discontinue the transfusion. 2. Send to the blood bank: a. A transfusion reaction report with a complete description of the reaction symptoms b. The blood container and all tubing used in the transfusion; clamp the tubing so contamination does not occur in transit. Remove the needle for safety. c. Posttransfusion specimens: one clot tube and one EDTA tube, properly labeled. 3. Send to the lab: a. The first available urine specimen to check for presence of hemoglobin with instructions to notify the blood bank of any abnormal finding

Laboratory Manual

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REAGENTS Panel and panel sheets Segment from units Anti-A Anti-B Anti-D Rh (D) control Anti-IgG or polyspecific AHG IgG-sensitized red cells

PROCEDURE 1. Check all paperwork for agreement. 2. Examine the posttransfusion anticoagulated specimen for hemolysis or icterus. Indicate the observation on the form. 3. Perform ABO and D phenotype on pretransfusion and posttransfusion specimens, and segment from the bag. Record the results. 4. Perform a DAT on pre- and posttransfusion specimens using EDTA specimen if available. Record results. 5. If all testing on ABO and D agrees and both DATs are negative, no further testing is indicated. If there is an ABO and/or D discrepancy or positive DAT, complete the rest of the procedure. 6. Repeat all compatibility testing, with pre- and post-recipient specimens and segment from the bag. Record results. 7. Perform an antibody screen on pre- and post- specimens. If antibody is detected, identify the antibody and check the unit for presence of the antigen. NOTE In some instances, the patient may have signs of a hemolytic reaction such as a decrease in hemoglobin and hematocrit or less than the expected rise in these tests. The DAT may be negative, in this instance, because a developing antibody is below detectable levels. It is advisable to perform an elution and an antibody identification using very sensitive enhancement techniques. Finding an antibody before giving the patient more red blood cells is crucial to avoid another reaction and potential resulting complications.

Laboratory Manual

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WORKSHEET FOR TRANSFUSION REACTION Patient’s Name _____________________ ID# ______________________ DOB______________ Physician _________________________ Diagnosis___________________ Transfusion History (previous reactions, antibodies) ____________________________________ Unit(s) Transfused __________________________________ Product_____________________ Unit(s) Transfused __________________________________ Product_____________________ Clinical Symptoms:

Fever _____ Chills _____ Pain ______ Hives _____

Vital Signs:

Temp (before) _____ (after) ______ Blood Pressure________________ Pulse_______________________

Clerical Check: _____acceptable _____unacceptable Visual Specimen Check:

Pretransfusion: Posttransfusion:

____ hemolysis ____ hemolysis

____ icterus ____ icterus

DAT: Pretransfusion: _______ Posttransfusion: _______ Eluate (if necessary) _____________________________________________________________ Antibody Screen: Pretransfusion: _________ Posttransfusion: _________ Antibody Identification ___________________________________________________________ Compatibility Testing Interpretation:

Pretransfusion: ________ Posttransfusion: __________

Summary of Laboratory Results ___________________________________________________ Evaluation by Medical Director ___________________________________________________ Recommendations ______________________________________________________________ Documented in Permanent Record _____________ Tech __________ Date _________________

Laboratory Manual

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STUDY QUESTIONS – LAB 14 1. What product would you recommend for a patient with chronic anemia who has had three febrile nonhemolytic transfusion reactions last year? Fresh whole blood (less than 48 hours old) Leukoreduced blood (filtered) Washed blood Frozen blood Group O Rh(D)-negative blood 2. What is the most common cause of severe or fatal transfusion reactions? 3. List the symptoms of an allergic reaction. 4. List the symptoms of a febrile reaction. 5. List the symptoms of a hemolytic reaction. 6. When comparing the pre- and post-reaction specimens, what observations are noted? 7. List three nonserologic causes of a hemolytic transfusion reaction. 8. What antibody is responsible for many delayed hemolytic reactions and why? 9. In most transfusion labs, a transfusion reaction workup is considered a STAT, ASAP, or routine priority? Why? 10. Compare and contrast the lab results you would expect to find in a febrile reaction versus a hemolytic reaction....