DELAYED TRANSFUSION REACTION — Transcript

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1. 0:01assalamualaikum and good day students
2. 0:05we will continue on the second part of
3. 0:08the lecture in the topic of adverse
4. 0:10effects of transition
5. 0:18i will continue with the delayed
6. 0:20hemolytic transmission reaction this
7. 0:22transmission reaction occurs usually
8. 0:24after 24 hours
9. 0:26but less than 28 days
10. 0:29the common reason is mostly due to
11. 0:31secondary immune response
12. 0:33following re-exposure to a given red
13. 0:36cell's antigen
14. 0:39the recipient actually has been
15. 0:41previously exposed to foreign antigen in
16. 0:43pregnancy
17. 0:44or previous transmission or transplant
18. 0:47and it will produce antibody against the
19. 0:50red cells antigen
20. 0:52for example during pregnancy
21. 0:55probably the fetus has red cells antigen
22. 0:58that is absent in the mother
23. 1:00during pregnancy the minimal amount of
24. 1:03fetal blood entering the mother
25. 1:05circulation and the mother will be
26. 1:08exposed to the results antigen that is
27. 1:11not part of her antigen
28. 1:14and the mother's body will produce
29. 1:16antibody against that red cell's antigen
30. 1:20but after some time this antibody level
31. 1:23will be reduced and is not detectable by
32. 1:27the standard pre-transmission method
33. 1:30so the antibody screening will be
34. 1:32negative during transfusion patient may
35. 1:36re-expose to that antigen if the donald
36. 1:38red cells have that antigen after a few
37. 1:42days of that subsequent transition there
38. 1:45will be a rapid increase the antibody
39. 1:47concentration which we call amnestic
40. 1:50response and this will result in the
41. 1:52destruction of the red cells
42. 1:54because the antibody
43. 1:56will attack the red cells antigen on the
44. 2:00donald cells and this will cause lysis
45. 2:03of the red cells
46. 2:05the haemolysis is usually extravascular
47. 2:08because most of the time these immune
48. 2:10antibodies are igg type and they are not
49. 2:14igm type so they will cause
50. 2:17extravascular hemolysis
51. 2:20the common blood antigen that involved
52. 2:23in this delayed hemolytic transmission
53. 2:25reaction is
54. 2:26rh
55. 2:27kid duffy and also cal antigen
56. 2:32this is the bacterophysiology how does
57. 2:35this happen so for example during
58. 2:37pregnancy
59. 2:40the mother will be exposed to the
60. 2:42foreign antigen from the fetal red cells
61. 2:45and then it will take about one week
62. 2:48after exposure the mother will produce
63. 2:51the antibody against the red cells
64. 2:54and if after delivery the model does not
65. 2:58being exposed to that antigen anymore
66. 3:01then the antibody level will be very
67. 3:04very low and if the mother need
68. 3:06translation
69. 3:08long after her pregnancy
70. 3:11probably
71. 3:12the level of antibody cannot be detected
72. 3:16by our antibody screening
73. 3:18because the concentration of antibody
74. 3:21has been very very low
75. 3:24subsequently after transmission the
76. 3:26donor red cells might contain the
77. 3:29antigen against the antibody that the
78. 3:32mother has
79. 3:33so
80. 3:34the mother after few days will produce
81. 3:37the antibody which is
82. 3:39usually igg
83. 3:41and this will cause lysis of the red
84. 3:44cells and lysis is usually extra
85. 3:47vascularizes
86. 3:49why do we call this delayed hemolytic
87. 3:52translation reaction because
88. 3:54it will take few days to reproduce the
89. 3:59antibody inside her circulation
90. 4:02in contrast to the acute hemolytic
91. 4:05transformation reaction because the igm
92. 4:09nta
93. 4:10ntb and nta comma b is the existing
94. 4:13antibody in our circulation so it does
95. 4:17not need time to
96. 4:19pre-produce it so it will attack it
97. 4:21acutely that is the difference between
98. 4:24the acute and delayed hemolytic
99. 4:26transfusion reaction
100. 4:29the clinical features is usually milder
101. 4:31than the acute hemolytic transmission
102. 4:34reaction and sometimes we cannot detect
103. 4:37it clinically
104. 4:39but if the patient shows symptoms they
105. 4:41will usually present with fever anemia
106. 4:45and also mild jaundice
107. 4:47investigation similar to the acute
108. 4:50hemolytic transfusion reaction and
109. 4:52sometimes we can see the lat findings of
110. 4:56jaundice
111. 4:57bilirubin will be slightly high
112. 4:59and then the antiglobulin test will be
113. 5:01positive the patient will be anemic even
114. 5:04though the patient has received few
115. 5:06kinds of blood
116. 5:08and when we send the blood to the blood
117. 5:12bank they will identify the red cells
118. 5:15antibody and in the peripheral blood
119. 5:17picture we will see signs of
120. 5:20extravascular hemolysis such as sphero
121. 5:23sites here
122. 5:28how do we want to prevent this from
123. 5:30happening
124. 5:31so we need to have free transmission
125. 5:33testing which is more sensitive so it
126. 5:37can detect even though the antibody
127. 5:39concentration is very low
128. 5:42and also we need to have access to the
129. 5:44previous record sometime the patient has
130. 5:46been admitted to other hospital so we
131. 5:50could not trace the previous records
132. 5:53from there but if the patient has
133. 5:56developed antibody usually the doctor
134. 5:59will tell the patient or the blood bank
135. 6:02will issue a card
136. 6:04to give to the healthcare professionals
137. 6:06in at the hospital if they need
138. 6:09transfusion because the cat will tell
139. 6:11them that they have red cells antibody
140. 6:15and it's also very crucial to have
141. 6:17proper history taking of the patient
142. 6:19because we want to know whether this
143. 6:20patient has been pregnant before
144. 6:22or history of translation before or
145. 6:24history of transplant before so all
146. 6:27these three factors are the major
147. 6:29factors of
148. 6:31exposure to the foreign red cells
149. 6:32antigen and of course we need to train
150. 6:35our lab staff so that they are more
151. 6:38aware
152. 6:39how to detect the antibody