Blood transfusion reactions and autoantibodies | Immunology | First Aid Lectures | Lec26 #drjamil
Channel: Dr. Jamil Lectures
Date: 2022-04-15

In this lecture we will discuss about Blood transfusion reactions like Allergic anaphylactic reaction,Acute hemolytic transfusion reactions,febrile nonhemolytic transfusion reactions,transfusion related acute lung injury and delayed hemolytic transfusion reactions and autoantibodies.


https://youtu.be/ZQFOLdoc_W4
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Allergic/anaphylactic reaction
Type I hypersensitivity reaction against plasma proteins in transfused blood
IgA-deficient individuals should receive blood products without IgA.
Within minutes to 2-3 hr (due to release of preformed inflammatory mediators in degranulating mast cells
Allergies: urticaria, pruritusAnaphylaxis: wheezing, hypotension, respiratory arrest, shock 
Acute hemolytic transfusion reaction
Type II hypersensitivity reactionTypically causes intravascular hemolysis 
(ABO blood group incompatibility)
During transfusion or within 24 hr (due to preformed antibodies)
Fever, hypotension, tachypnea, tachycardia, flank pain, hemoglobinuria (intravascular), jaundice (extravascular).
Febrile nonhemolytic transfusion reaction
Cytokines created by donor WBCs accumulate during storage of blood productsReactions prevented by leuko reduction of blood products.
Within 1-6 hr (due to preformed cytokines).
Fever, headaches, chills, flushingMore common in children.
Transfusion related acute lung injury
Two-hit mechanism:
 Neutrophils are sequestered and primed in pulmonary vasculature due to recipient risk factors
 Neutrophils are activated by a product (eg, antileukocyte antibodies) 
in the transfused blood and release inflammatory mediators increase capillary permeability and cause pulmonary edema.
Within minutes to 6 hr
Respiratory distress, noncardiogenic pulmonary edema.
Delayed hemolytic transfusion reaction
Anamnestic response to a foreign antigen on donor RBCs (most commonly )
Onset over 24 hrUsually presents within 1-2 wk (due to slow destruction by reticuloendothelial system)Rh or other minor blood group antigens) previously encountered by recipientTypically causes  extravascular hemolysis
Generally self limited and clinically silent Mild fever, hyperbilirubinemia


Autoantibodies
Anti-postsynaptic ACh receptor Myasthenia gravis
Anti-presynaptic voltage-gated calcium channel Lambert-Eaton myasthenic syndrome
Anti-β2 glycoprotein I Antiphospholipid syndrome
Nonspecific screening antibody, often associated 
with SLE
Antinuclear (ANA)
Anticardiolipin, lupus anticoagulant SLE, antiphospholipid syndrome
Anti-dsDNA, anti-Smith SLE
Antihistone Drug-induced lupus
Anti-U1 RNP (ribonucleoprotein) Mixed connective tissue disease
Rheumatoid factor (IgM antibody against IgG Rheumatoid arthritis
Fc region), anti-CCP (more specific)
Anti-Ro/SSA, anti-La/SSB Sjögren syndrome
Anti-Scl-70 (anti-DNA topoisomerase I) Scleroderma (diffuse)
Anticentromere Limited scleroderma (CREST syndrome)
Antisynthetase (eg, anti-Jo-1), anti-SRP, anti- Polymyositis, dermatomyositis
helicase (anti-Mi-2)
Antimitochondrial 1° biliary cholangitis
Anti-smooth muscle Autoimmune hepatitis type 1
Microscopic polyangiitis, eosinophilic 
granulomatosis with polyangiitis (ChurgStrauss syndrome), ulcerative colitis
MPO-ANCA/p-ANCA
PR3-ANCA/c-ANCA Granulomatosis with polyangiitis (Wegener)
Anti-phospholipase A2 receptor 1° membranous nephropathy
Anti-hemidesmosome Bullous pemphigoid
Anti-desmoglein (anti-desmosome) Pemphigus vulgaris
Antithyroglobulin, antithyroid peroxidase Hashimoto thyroiditis
(antimicrosomal)
Anti-TSH receptor Graves disease
IgA anti-endomysial, IgA anti-tissue Celiac disease
transglutaminase, IgA and IgG deamidated 
gliadin peptide
Anti-glutamic acid decarboxylase, islet cell Type 1 diabetes mellitus
cytoplasmic antibodies
Antiparietal cell, anti-intrinsic factor Pernicious anemia
Anti-glomerular basement membrane Goodpasture syndrome
FAS1_2019_02-Immunology.indd 115 

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