Transfusion Reactions for Bloodbank Operations

Transfusion Reactions

One of the most important categories to a medical lab technician working in the bloodbank is the subject of transfusion reactions. The technician needs to be aware of all potential issues that could be seen if a deviation from operating instructions and regulations occurs. In the bloodbank section, the patient’s life is in the hands of the medical lab technician. Any discrepancies in blood typing or crossmatching could critically injure someone or more importantly, cause death.  Although many reactions occur due to negligence on behalf of the lab technician and/or the person administering the transfusion, not all reactions can be avoided. No matter what the reason for the reaction, the technician must educated him or herself thoroughly and know how to recognize reactions when called upon to provide an explanation. Not only will knowledge help fuse situations as they arise, but it will also keep the technician from sending out blood that should not be transfused.

A transfusion reaction is a reaction that occurs when a person receives a blood component (transfusion) during surgery or for therapeutic reasons and their body reacts to it in a negative manner. The body basically goes into protective mode and tries to fight off anything that does not belong. When this happens, problems occur within the patient. Some reactions are accompanied with fever and occur immediately, while others show no signs for days and even weeks. There are two main types of transfusion reactions: acute and delayed. These reactions are further broken down into four types: acute immunologic, acute nonimmunologic, delayed immunologic, and delayed nonimmunologic. In order to help decide between acute and delayed, there are two main questions that need to be answered. The first question is “how long after transfusion did the reaction occur?” The second question is “was the immune system involved?” Immunologic reactions are also called febrile reactions because they are accompanied by fever in the patient. Nonimmunologic reactions are also known as afebrile reations, meaning they are not accompanied by fever. Acute reactions normally occur within 48 hours, while delayed reactions occur after 48 hours. Remembering this distinction assists the lab technician and nurse/physician when a reaction occurs.

Acute immunologic transfusion reactions occur when there is a red blood cell incompatibility and recipient’s antibodies react to antigens on donor’s red cells. This type of reaction describes a hemolytic transfusion reaction (HTR). There are three main types of acute immunologic transfusion reactions. The first type is febrile non-hemolytic transfusion reaction (FNHR). Febrile means fever. In FNH, there is at least a one degree rise in recipient’s body temperature due to the immune response directed when the patient’s antibodies are directed against the donor’s platelets or white blood cells. The second type occurs when there is an allergic reaction. The reaction in this case can be mild, moderated, or life threatening. A third type under acute immunologic transfusion reactions is commonly referred to “TRALI” (Transfusion-Related Acute Lung Injury). This type of reaction is usually associated with passively transfused antibodies to HLA or neutrophil antigens that react with the recipient’s granulocytes (type of white blood cell that helps in the immune response as the body tries to fight off foreign substances).