tailieunhanh - Chapter 107. Transfusion Biology and Therapy (Part 6)

Immune-Mediated Reactions Acute Hemolytic Transfusion Reactions Immune-mediated hemolysis occurs when the recipient has preformed antibodies that lyse donor erythrocytes. The ABO isoagglutinins are responsible for the majority of these reactions, although alloantibodies directed against other RBC antigens, ., Rh, Kell, and Duffy, may result in hemolysis. Acute hemolytic reactions may present with hypotension, tachypnea, tachycardia, fever, chills, hemoglobinemia, hemoglobinuria, chest and/or flank pain, and discomfort at the infusion site. Monitoring the patient's vital signs before and during the transfusion is important to identify reactions promptly. When acute hemolysis is suspected, the transfusion must be stopped immediately, intravenous access maintained, and the reaction reported. | Chapter 107. Transfusion Biology and Therapy Part 6 Immune-Mediated Reactions Acute Hemolytic Transfusion Reactions Immune-mediated hemolysis occurs when the recipient has preformed antibodies that lyse donor erythrocytes. The ABO isoagglutinins are responsible for the majority of these reactions although alloantibodies directed against other RBC antigens . Rh Kell and Duffy may result in hemolysis. Acute hemolytic reactions may present with hypotension tachypnea tachycardia fever chills hemoglobinemia hemoglobinuria chest and or flank pain and discomfort at the infusion site. Monitoring the patient s vital signs before and during the transfusion is important to identify reactions promptly. When acute hemolysis is suspected the transfusion must be stopped immediately intravenous access maintained and the reaction reported to the blood bank. A correctly labeled posttransfusion blood sample and any untransfused blood should be sent to the blood bank for analysis. The laboratory evaluation for hemolysis includes the measurement of serum haptoglobin lactate dehydrogenase LDH and indirect bilirubin levels. The immune complexes that result in RBC lysis can cause renal dysfunction and failure. Diuresis should be induced with intravenous fluids and furosemide or mannitol. Tissue factor released from the lysed erythrocytes may initiate DIC. Coagulation studies including prothrombin time PT activated partial thromboplastin time aPTT fibrinogen and platelet count should be monitored in patients with hemolytic reactions. Errors at the patient s bedside such as mislabeling the sample or transfusing the wrong patient are responsible for the majority of these reactions. The blood bank investigation of these reactions includes examination of the pre- and posttransfusion samples for hemolysis and repeat typing of the patient samples direct antiglobulin test DAT sometimes called the direct Coombs test of the posttransfusion sample repeating the cross-matching of the blood .

• Y học thường thức
• Transfusion Biology and Therapy
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu học ngành y
• Harrisons Internal Medicine
• medical books
• pharmacology
• epidemiologic
• Obstetrics
• anatomy
• Preventing Morbidity
• Multidisciplinary Care