Blood and Blood Product Transfusion Reaction

History of blood group In 1900, the German pathologist, Karl Landsteiner, identified 2 of antigenic proteins, which he called A and B In 1940, Dr. Landsteiner discovered another group of antigens. They were named Rhesus factors (Rh factors) because they were discovered during experiments on Rhesus monkeys The surface of red blood cells contain several proteins that can be identified by the body as antigens

Definition & Path physiology Transfusion reaction is a complication of blood transfusion where there is an immune response against the transfused blood cells or other components of the transfusion

ABO & Rh compatibility Blood is classified according to the presence of these antigens: Group A contains antigen A Group B contains antigen B Group AB contains both antigens Group O contains neither antigen Blood plasma contains antibodies against the opposite antigen: A person with Type A blood has antibodies against the B antigen A person with Type B blood has antibodies against the A antigen A person with Type AB blood has no antibodies (Universal Recipient) A person with Type O blood has antibodies against the A,B&AB antigens (Universal Donor)

ABO & Rh compatibility People with Rhesus factors in their blood are classified as "Rh positive" People without the factors are classified as "Rh negative" Rh negative persons form antibodies against the Rh factor if they are exposed to Rh positive blood Conclusion: Blood transfusion between incompatible groups causes an immune response against the cells carrying the antigen, resulting in transfusion reaction

Path physiology Immune system release antibodies Attach to a specific antigen and Cause its destruction Antigens enter the body Transfusion reaction occurred

Symptoms Fever Chills Rash Flank pain or back pain Bloody urine Fainting or dizziness Symptoms of transfusion reaction usually appear: during transfusion immediately after the transfusion may develop after several days (delayed reaction)

Complications Discomfort Anemia Acute kidney failure Shock Lung dysfunction

IMMEDIATE INTERVENTION If symptoms occur during the transfusion: Stop the infusion Give reaction medications if ordered Inform the doctor Order Transfusion Reaction Workup with the components: Transfusion reaction Direct coombs Urine analysis Send blood bag, tubing and the collected specimens to the blood bank Fill blood transfusion reaction form Documentation

Medical Treatment Antihistamines such as diphenhydramine to reduce itching and rash Acetaminophen recommended to reduce fever and discomfort Corticosteroids such as prednisone or dexamethasone to reduce the immune response Intravenous fluids and various medications used to treat/prevent kidney failure and shock

Prevention Typing of donated blood into ABO and Rh groups has reduced the risk of transfusion reaction: Prior to a transfusion, blood is usually crossmatched to further confirm that the blood is compatible A small amount of donor blood is mixed with a small amount of recipient blood and the mixture is examined under a microscope for signs of antibody reaction Give Rhogam which is a sterile solution containing IgG anti-D(RH1) for use in preventing Rh immunization