SBB 561 Delayed Transfusion Reactions

  1. Delayed HTR most common signs
    • Fever
    • Declining Hgb (extravascular hemolysis)
    • mild Jaundice
  2. Most common antibodies associated with delayed HTR
    • Kidd
    • Kell
    • Duffy
    • c
    • D
    • E
  3. Delayed Immunologic alloimmunization causes and serology presentations
    Immune response to foreign antigens on RBC, or WBC and platelets (HLA).

    DAT may become postive before antibody levels are detectable. 

    May need to elute antibody off RBC's to identify

    XM may still be compatible initially (when titers are still too low)
  4. TA-GVHD Pathophysiology
    • Not fully known - 
    • Initiated by alloreactive donor T cells recognizing host histocompatibility antigens
    • Donor lymphs engraft in the recipient, proliferate, and attack host tissue.
  5. TA-GVHD Clinical presentation
    • 10-12 days post transfusion:
    • Fever, dermatitis/erythroderma, hepatitis, enterocolitis, pancytopenia, & immunodeficiency
  6. TA-GVHD increased risk factors are:
    • Degree of HLA similarity
    • immunocmepetent heterozygous HLA haplotype recipient of a donor who is homozygous for an HLA haplotype and component contains many T-lymphs. 
    • Presence & degree of recipient immunodeficiency. 
    • jNumber of transfused lymphs cappable of multiplying
  7. Prevention:
    • Irradiation: Minimum 2500 cGy to midplane of container and 1500 cGy to other parts.
    • This prevents T lymphs of replication and at the same time not destroying cellular function.
  8. AABB Standard 5.17.3 (2018) regarding TA-GVHD recommendation for irradiation
    • Cellular components for intrauterine transfusions
    • At risk patients
    • Cellular transfusion between blood relatives
    • Transfusion of HLA selected products
Card Set
SBB 561 Delayed Transfusion Reactions
SBB 561 Delayed transfusion reactions