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Free blood pressure tests supporting a hypertension awareness initiative.(campaign for hypertension)(Brief article)

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Definition

Transfusion reaction is a problem that occurs after a patient receives blood. The immune system launches a response against the new blood cells or other parts of the transfusion.

Alternative Names

Blood transfusion reaction

Causes

The immune response protects the body from harmful substances. Foreign substances called antigens cause many immune responses. They trigger the production of proteins, called antibodies, which attach to antigens and help destroy them. They also trigger a type of white blood cell called lymphocytes, which recognize a certain antigen and destroy it.

The immune system normally can tell its own blood cells from other cells. On the surface of red blood cells are proteins that the body sees as antigens. In 1900, a German disease expert (pathologist), Karl Landsteiner, found 2 of these proteins, which he called A and B.

Blood is arranged by these antigens into blood types A, B, AB (contains both antigens), and O (contains neither antigen). The liquid part of blood (plasma) has antibodies against the opposite antigen. A person with Type A blood, for example, has antibodies against the B antigen.

In 1940, Dr. Landsteiner found another group of antigens. They were named Rhesus factors (Rh factors) because they were discovered during experiments on Rhesus monkeys.

People with Rhesus factors in their blood are called “Rh positive.” Persons without the factors are called “Rh negative.” Rh negative people form antibodies against the Rh factor if they are exposed to Rh positive blood.This can be a problem in an Rh negative mother who is pregnant with an Rh positive baby. There are other antigens too, besides ABO and Rh antigens.

Having antibodies against blood antigens makes blood groups compatible or incompatible. Tranfusing blood between compatible groups (such as O+ to O+) usually causes no problem. Blood transfusion between incompatible groups (such as A+ to O-) causes an immune response against the cells carrying the antigen. This can lead to a transfusion reaction.

The immune system attacks the donated blood cells, causing them to burst. This may cause serious symptoms, including kidney failure and shock. Antigens also occur in other parts of blood, including white blood cells, a type of blood cell called platelets, and plasma proteins.

These parts of the blood also cause a similar type of transfusion reaction. Or, antibodies in the transfused blood can bind to the patient’s blood cells, causing a reaction.

Today, all blood is carefully screened. Modern lab methods and many checks have helped make transfusion reactions very rare.

Symptoms

• Fever
• Chills
• Rash
• Flank pain or back pain
• Bloody urine
• Fainting or dizziness

Exams and Tests

Symptoms of transfusion reaction usually appear during or right after the transfusion. Sometimes, they may develop after several days (delayed reaction). Symptoms may stay mild or progress to kidney failure, delayed anemia, or shock.

This disease may also change the results of these tests:

• RBC count
• Hemoglobin; serum
• Hemoglobin
• Hematocrit
• Haptoglobin
• Fibrin degradation products
• Coombs’ test, indirect
• Coombs’ test, direct
• CBC
• Bilirubin

Treatment

Treatment can prevent or treat the severe effects of transfusion reaction. If symptoms occur during the transfusion, the transfusion is stopped. Blood samples from the person getting the transfusion (and from the donor blood) may be tested to tell whether symptoms are caused by transfusion reaction.

Mild symptoms may be treated based on the symptom. Drugs called antihistamines (such as diphenhydramine) treat the allergic reaction and may reduce itching and rash. The pain reliever, acetaminophen, can reduce fever and discomfort. Drugs called corticosteroids (such as prednisone or dexamethasone) reduce the immune response. Fluids given through a vein (intravenous) and other medications may be used to treat/prevent kidney failure and shock.

Outlook (Prognosis)

The outcome depends on how severe the reaction is. The disorder may disappear without problems. Or, it may be severe and life threatening.

Possible Complications

• Discomfort
• Anemia
• Acute kidney failure
• Shock
• Lung dysfunction

When to Contact a Medical Professional

Tell your health care provider if you are having a blood transfusion and you have had a reaction before.

Prevention

Donated blood is put into ABO and Rh groups to reduce the risk of transfusion reaction.

Before a transfusion, patient and donor blood is often tested (crossmatched) to see if it is compatible. A small amount of donor blood is mixed with a small amount of patient blood. The mixture is checked under a microscope for signs of antibody reaction.

References

Hoffman R, Benz E, Shattil S, Furie B, Cohen H. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, Pa: Churchill Livingstone, 2004.

McPherson RA, Pincus MR. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. Philadelphia, Pa: Saunders, 2006.

Despotis GJ, Zhang L, Lublin DM. Transfusion risks and transfusion-related pro-inflammatory responses. Hematol Oncol Clin North Am. February 2007;21:147-161.

Definition

Hypoglycemia is a condition that occurs when your blood sugar (glucose) is too low.

Alternative Names

Insulin shock; Low blood sugar

Causes

Hypoglycemia results when your body’s glucose is used up too rapidly, when glucose is released into the bloodstream too slowly, or when too much insulin is released into the bloodstream. Insulin is a hormone that reduces blood glucose. It is produced by the pancreas in response to increased glucose levels in the blood.

Hypoglycemia is relatively common in persons with diabetes. It occurs when too much insulin or diabetes medicine is taken, not enough food is eaten, or from a sudden increase in the amount of exercise without an increase in food intake.

Relative hypoglycemia is a fairly common condition in which a newborn’s blood glucose is low. Babies born to mothers with diabetes may have severe hypoglycemia.

Severe hypoglycemia is a medical emergency that may result in seizures and damage to the baby’s nervous system if not treated.

Severe hypoglycemia that results in unconsciousness is also called insulin shock.

Idiopathic hypoglycemia is hypoglycemia that occurs without a known cause. Persons with this type of hypoglycemia do not have diabetes.

Hypoglycemia may also be caused by:

• Insulin-secreting tumor of the pancreas
• Liver disease
• Ingestion of alcohol

It affects approximately 1 out of every 1,000 people.

Symptoms

• Cold sweats
• Confusion
• Convulsions
• Coma
• Double vision or blurry vision
• Fatigue
• General discomfort, uneasiness, or ill feeling (malaise)
• Headache
• Hunger
• Irritability (possible aggression)
• Nervousness
• Rapid heart rate
• Trembling

Other symptoms that may be associated with this disease:

• Decreased alertness
• Different size pupils
• Dizziness
• Excessive sweating
• Fainting
• Hallucinations
• Memory loss
• Muscle pain
• Paleness
• Pounding heartbeat (heartbeat sensations)
• Sleeping difficulty

Exams and Tests

Home monitoring of blood glucose levels will show readings lower than 50 mg/dL.

Serum glucose test will be low.

This disease may also alter the results of the following tests:

• Glucose tolerance test
• CSF collection
• Blood glucose monitoring

Treatment

A snack or drink containing sugar will raise the blood glucose level. You should see an immediate improvement in symptoms.

Infants that are born with hypoglycemia are given glucose through a vein until the body begins to control its own blood sugar level.

Persons with severe hypoglycemia are treated with glucose injections or the hormone glucagon. Immediate treatment is needed to prevent serious complications or death.

Your doctor may tell you to change your diet so that you get more even amounts of glucose into your body throughout the day. This may prevent further episodes of low blood sugar. You may be told to eat small, frequent meals with complex carbohydrates, fiber, and fat and to avoid simple sugars, alcohol, and fruit juice.

You should also eat meals at regular intervals, and balance extra exercise with extra food.

If hypoglycemia is caused by an insulinoma (insulin-secreting tumor), surgery to remove the tumor is the best treatment.

Possible Complications

Untreated, hypoglycemia can lead to loss of consciousness and coma. In infants, seizures and permanent damage to the nervous system may occur.

Learn to recognize the early warning signs of hypoglycemia and treat yourself rapidly and appropriately.

When to Contact a Medical Professional

Go to the emergency room immediately or call a local emergency number (such as 911) if early signs of hypoglycemia do not improve after you’ve eaten a snack containing sugar.

Get immediate medical help if a person with diabetes or a history of hypoglycemia loses alertness or if you can’t wake them up.

Prevention

If you have diabetes, make sure you follow your doctor’s advice regarding diet, medications, and exercise.

If you have a history of hypoglycemia, you should keep a snack or drink containing sugar available at all times to take as soon as symptoms appear. If symptoms do not improve in 15 minutes, additional food should be eaten. A glucagon kit is available for those who have episodes of hypoglycemia that respond poorly to other types of treatment.

References

Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003; 26(6): 1902-1912.

blood groups, differentiation of blood by type, classified according to immunological (antigenic) properties, which are determined by specific substances on the surface of red blood cells. Blood groups are genetically determined and each is characterized by the presence of a specific complex carbohydrate. About 200 different blood group substances have been identified and placed within 19 known blood group systems. The most commonly encountered blood group system is the ABO, or Landsteiner, system. Individuals may contain the A, B, or both A and B antigenic substances, or else lack these substances (type O). In the ABO system an individual who lacks one or more of these antigens will spontaneously develop the corresponding antibodies (agglutinins) shortly after birth. Thus a person with A type blood will naturally produce anti-B agglutinins, a person with B blood will produce anti-A agglutinins, and a person with O blood will produce anti-A and anti-B agglutinins; but a person with AB blood will not produce any agglutinins in this blood group system. Since these agglutinins are always present in the blood, in blood transfusion the donor blood must be compatible with the recipient’s blood, i.e., the donor’s blood must not contain antigen corresponding to the recipient’s antibody. Other blood group systems, such as the MNSs, Lewis, Lutheran, and P systems, are not as important in transfusion because they act like true antigen-antibody systems, i.e., antibodies do not appear in blood plasma until the individual has been immunized by exposure to the other blood group antigens as in previous transfusions. In general, blood group substances are weak antigens, and antibody formation after transfusion occurs less than 3% of the time. Immunization can occur by pregnancy as well as by transfusion. Thus, in the Rh factor blood group system, an Rh-negative mother carrying an Rh-positive fetus produces anti-Rh antibodies against fetal red blood cells that cross the placenta. Since blood type is a genetic trait that is easy to test and the blood type of an individual is related to his or her parent’s blood types by the laws of Mendelism (see under Mendel, Gregor), blood group typing is used legally to establish paternity. Anthropologists use the frequency of occurrence of various blood groups as tools to study racial or tribal origins.

The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2007, Columbia University Press. All rights reserved.

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