Term
| What is a transfusion reaction? |
|
Definition
| adverse event that occurs as a result of infusing blood components |
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|
Term
| What are the different types of transfusion reactions? |
|
Definition
| hemolytic (acute and delayed) and nonhemolytic= immune but not against red cell antigens (allergic, TRALI, anaphylactic, TA-GVHD), bacterial ("septic") and other (fluid overload, iron overload) |
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|
Term
| What percent of transfusion fatalities are due to ABO incompatibility? |
|
Definition
|
|
Term
| What are the classic signs/symptoms of acute hemolytic transfusion reaction? |
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Definition
| burning sensation at infusion site, pain in lumbar region, fever/chills, hypotension, vomiting/diarrhea, feeling of doom |
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Term
| Half of the time the only symptom of a hemolytic transfusion reaction is ______. |
|
Definition
| fever, with or without chills |
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|
Term
| What are the complications of intravascular (acute) hemolytic transfusion reactions? |
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Definition
| acute renal failure, shock, DIC, complement mediated cardiovascular collapse, death |
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Term
| How do you treat acute, intravascular hemolytic transfusion reactions? |
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Definition
| keep urine output >100 mL/hr with fluids/diuretics, analgesics, pressors for hypotension, hemostatic components for bleeding, renal consult |
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|
Term
| What are the early changes in lab values after an intravascular hemolytic transfusion reaction? |
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Definition
decreased haptoglobin, hemoglobinemia, hemoglobinuria, increased LDH, positive DAT
soon after= increased serum bilirubin |
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Term
| How do you tell if a red urine sample is red because of bleeding or because of hemoglobin? |
|
Definition
| centrifuge; if there is a red pellet at the bottom with clear fluid it was bleeding |
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|
Term
| How long does it take for a "delayed" hemolytic transfusion reaction to manifest? |
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Definition
| 3-14 days after transfusion |
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Term
| WHat can you ask the patient to determine whether they are at risk of delayed hemolytic transfusion reaction? |
|
Definition
| history of transfusion or pregnancy |
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|
Term
| What are the symptoms of delayed hemolytic transfusion reaction? |
|
Definition
| low grade fever,anemia, mild jaundice, can be asymptomatic to a severe immunologic response |
|
|
Term
| Which labs are affected by delayed hemolytic transfusion reaction? |
|
Definition
| DAT positive, positive antibody screen, hyperbilirubinemia |
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Term
| What are the immune, nonhemolytic transfusion reactions? |
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Definition
| febrile non-hemolytic transfusion reaction (FNHTR), transfusion related acute lung injury (TRALI), allergic, post-transfusion purpura, neonatal alloimmune thrombocytopenia (NAIT) |
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|
Term
| What is the definition of FNHTR? |
|
Definition
| temperature rise of more than 1 degree celsius or 2 degrees farenheit during or shortly after transfusion |
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|
Term
|
Definition
| recpient antibodies against donor white blood cells; may also involve accumulated cytokines from WBCs in the stored blood products (ex. 4 day old platelets) |
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|
Term
| What are the symptoms of FNHTR? |
|
Definition
| fever, chills (seldom involve hypotension or respiratory distress) |
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|
Term
| What is the treatment of FNHTR? |
|
Definition
| symptomatic (i.e. antipyretics) |
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|
Term
| How do you prevent FNHTR? |
|
Definition
| leukoreduced blood products |
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|
Term
| TRALI is usually associated with what blood products? |
|
Definition
|
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Term
|
Definition
| donor antibodies against recipient's PMN's. This reaction occurs in the lung, activating pulmonary macrophages and increasing pulmonary vascular permeability |
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|
Term
| Why are multiparous females' plasma often thrown away? |
|
Definition
| because they have been exposed to many foreign WBCs who have antibodies against recipients PMNs causing TRALI |
|
|
Term
| What are the signs/symptoms of TRALI? |
|
Definition
| acute onset (4-6 hours) of dyspnea, hypotension, fever, bilateral pulmonary infiltrates |
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|
Term
| What is the treatment for TRALI? |
|
Definition
| supportive (intubation), resolves spontaneously if patient survives |
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Term
| What are the two types of allergic transfusion reactions? |
|
Definition
| urticarial and anaphylactic |
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|
Term
| What are the symptoms of urticarial transfusion reaction? |
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Definition
| urticaria, pruritis, flushing |
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|
Term
| What are the symptoms of anaphylactic transfusion reactions? |
|
Definition
| hypotension, urticaria, bronchospasm |
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|
Term
| What causes allergic and anaphylactic transfusion reactions? |
|
Definition
| substances (usually proteins) in donor blood to which recipient is alelrgic |
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Term
| What is a classical cause of allergic transfusion reaction? |
|
Definition
| anti-IgA in patients with congenital IgA deficiency |
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|
Term
| How do you prevent transfusion allergic reactions in patients with anti IgA? |
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Definition
|
|
Term
| How do you treat a patient with urticaria after begining transfusion? |
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Definition
| pretreatment with benadryl can help minimize allergic reactions. Restart transfusion after symptoms subside |
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|
Term
| What is the only type of transfusion reaction in which you can re-start the transfusion after sx subside? |
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Definition
|
|
Term
| How do manage anaphylaxis after transfusion? |
|
Definition
| oxygen, fluids, epinephrine, antihistamines/corticosteroids/beta2 agonists |
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|
Term
| What is the presentation of post transfusion purpura? |
|
Definition
| acute thrombocytopenia 1-2 weeks after transfusions of RBCs (usually) or platelets (RBCs contain some platelets) |
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|
Term
| What causes post-transfusion purpura? |
|
Definition
| in patients that are HPA-1a negative, they will form an antibody to HPA-1a antigen on donor platelets. This anti-platelet antibody destroys donor platelets and also cross reacts with the recipients own platelets. This causes the recipient's platelet count to drop dramatically |
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|
Term
| What percent of the population is HPA-1a negative? |
|
Definition
|
|
Term
| What is the treatment for post-transfusion purpura? |
|
Definition
| HPA-1a negative platelets; perhaps plasma pheresis (to remove the antibody) |
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|
Term
|
Definition
| HPA-1a negative mother reacts to foreign HPA-1a on the child |
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|
Term
| T/F In Neonatal alloimmune thrombocytopenia, both the mother and the fetus are thrombocytopenic. |
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Definition
| false; only baby is thrombocytopenic |
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Term
| T/F Neonatal Alloimmune Thrombocytopenia can occur in the first pregnancy. |
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Definition
|
|
Term
| What is the treatment for newborns with NAIT? |
|
Definition
| platelet replacement with HPA-1A negative platelets from Mom! |
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Term
| What type of patients get TA-GVHD? |
|
Definition
| severely immunocompromised (hematopoietic stem cell transplants, chemotherapy for hematologic malignancies) |
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Term
|
Definition
| donor T cells mount an immune attack against the recipient |
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Term
| What are the symptoms of TA-GVHD? |
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Definition
| fever, rash, diarrhea, liver dysfunction, pancytopenia. Most die within 3 weeks |
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Term
| How do you prevent TA-GVHD? |
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Definition
| irradiation of cellular blood products (platelets, RBCs) cross-links the DNA in the donor lymphocytes, preventing them from replicating; Also need a directed donation from a relative |
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Term
| What type of radiation is used to pretreat blood products given to immunocompromised hosts? |
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Definition
|
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Term
| What are non-immunologic and non-septic transfusion reactions? |
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Definition
| volume overload, iron overload, hypothermia, hypocalcemia (because anticoagulant chelates calcium), potassium toxicity (in infants), clotting factor deficiency (dilutional coagulopathy due to massive transfusion) |
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Term
| How can you minimize alloimmunization against platelet antigens? |
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Definition
| use apheresis (single donor) platelets; may even need HLA-matched platelets once immunized although 20-35% of patients who receive HLA-matched platelet transfusion are not benefitted |
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Term
| What methods are used to reduce transfusion transmitted infectious diseases? |
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Definition
| educational materials (donor self-assessment), donor health history questionnaire (risk factors), focused physical exam ("track marks"), infectious disease testing of the blood, donor deferral registry |
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Term
| How long are you deferred from donating blood if you have had a blood transfusion or organ, skin and bone transplant? |
|
Definition
|
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Term
| Name the reasons for permanent deferral for donating blood. |
|
Definition
| viral hepatitis after 11 yoa, IVDU, MSM since 1977, HBV, HCV, HIV, HTLV, transfusion of clotting factors, recieving $ or drugs for sex |
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Term
| What diseases are tested for on blood donations? |
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Definition
| anti-HBV (surface antigen), anti-HCV (NAAT), HIV antibodies and NAAT, anti HTLV-1 and 2, serology for syphilis, west nile virus (seasonal), chagas disease |
|
|
Term
| How many transfusions result in HIV transission? |
|
Definition
|
|
Term
| How many transfusions result in HCV transmission? |
|
Definition
|
|
Term
| How many transfusions result in HBV transmission? |
|
Definition
|
|
Term
| How many transfusions result in bacteria? |
|
Definition
|
|
Term
| How long after being thawed is FFP good for? |
|
Definition
| 24 hours at 1-6 degrees celcius; 4 hours if pooled |
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Term
| What are the different flora that can contaminate blood products? |
|
Definition
transient flora= adherent to keratin layer
superficial flora= in inner epidermal layer
deep resident flora= in hair follicles, sweat and sebaceous glands |
|
|
Term
| How do you prevent bacteria from skin from getting into donated blood? |
|
Definition
| contemporary needle design to minimize skin plug, diversion pouch for the first few mL of blood |
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Term
| What are the common gram negative bacteria in PRBCs? |
|
Definition
| yersinia enterocolitica, serratia liquifaciens or serratia marcescens, other enterobacteriaceae, psuedomonas |
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|
Term
| Gram negative bacteria are common in which blood products? |
|
Definition
| PRBCs because they can grow well at 1-6 degrees C (also can be in platelets) |
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|
Term
| Gram positive bacteria are common in which blood products? |
|
Definition
| platelets because at 20-24 C |
|
|
Term
| What are the common gram positive bacteria that contimate platelets? |
|
Definition
| staph (S. aureus and coag negative staph), strep, gram negative bacilli |
|
|
Term
| How frequently are platelets contaminated? |
|
Definition
|
|
Term
| How many contaminated platelets cause a severe septic transfusion reaction? |
|
Definition
|
|
Term
| Platelet products MUST be tested for _____ |
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Definition
|
|
Term
| How are people infected with Yersinia enterocolitica? |
|
Definition
| infection caused by ingestion of contminated food (such as pork) or water |
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|
Term
| What are the symptoms of RBC contamination by yersinia? |
|
Definition
| mild; perhaps diarrhea 1-2 weeks prior to donation but transient infection may be followed by a prolonged bacteremia |
|
|
Term
| T/F Yersinia grows well at 4 degrees celcius. |
|
Definition
|
|
Term
| What are the symptoms of gram negative septic transfusion reaction? |
|
Definition
| fever, rigors, hypotension (rigors, abdominal pain, N/V, shock) |
|
|
Term
| What are the symptoms of gram positive septic transfusion reaction? |
|
Definition
| signs and symptoms can be very mild; must havehigh index of suspicion to catch gram negative septic transfusion reaction |
|
|
Term
| What should you send to the blood bank if you suspect a transfusion reaction? |
|
Definition
| send post transfusion blood specimen, urine specimen, and remainder of blood product to blood bank |
|
|
Term
| What does the blood bank do when you have reported a transfusion reaction? |
|
Definition
| check for clerical errors, repeat ABO testing, DAT/antibody screen, visual check for hemoglobinemia |
|
|
Term
| T/F HDFN can not occur in a first pregnancy. |
|
Definition
| false, it can occur in a first pregnancy if mother has been sensitized by a prior transfusion |
|
|
Term
| What kind of Ig is responsible for HDFN? |
|
Definition
|
|
Term
| What are three historically distinct diseases that are all caused by HDFN? |
|
Definition
| erythroblastosis fetalis, hydrops fetalis, icterus neonatorum gravidum |
|
|
Term
| What is erythroblastosis fetalis? |
|
Definition
| destruction of fetal red cells causes increased extramedullary erythropoeisis in the liver and spleen; increased immature erythrocvytes (erythroblasts) in the circulation |
|
|
Term
| Describe the breakdown process of heme? |
|
Definition
| heme to biliverdin via heme oxygenase; biliverdin to unconjugated bilirubin via biliverdin reductase; unconjugated bilirubin to conjugated bilirubin by UDP glucuronyl transferase |
|
|
Term
| Why is the fetal liver unable to conjugate bilirubin? |
|
Definition
| does not produce enough UDP glucuronyl transferase |
|
|
Term
| When is hemolysis of Hemolytic disease of the newborn at maximum? |
|
Definition
|
|
Term
| What are the blood groups that cause HDN in order of importance? |
|
Definition
| 1) anti-Rh (anti-D)=severe 2) anti A and/or anti B= mild 3) anti-Kell and anti-Duffy= severe |
|
|
Term
| Whta is the most common cause of HDN? |
|
Definition
| anti-A or anti-B now that Rhogam is in widespread use |
|
|
Term
| What percent of the population is Rh negative? |
|
Definition
|
|
Term
| What percent of births are Rh negative mothers with Rh positive fetuses? |
|
Definition
|
|
Term
| Why doesn't every Rh- mother with an Rh+ fetus develop HDFN? |
|
Definition
| quantity of fetal blood cells reaching maternal circulation can be insufficient for sensitization, insufficient anti-Rh reaching fetal circulation, ABO incombatibility can be protective (RBCs destroyed by maternal IgM before mother can become sensitized to Rh antigen), Rh negative individual just isn't sensitive to Rh antigen, first pregnancy is not affected |
|
|
Term
| Mothers with what blood type have the greatest tendency to have HDFN due to ABO incompatibility? |
|
Definition
| group O have the greatest tendency to make high titer IgG ABO antibodies |
|
|
Term
| What percent of babies/mothers are ABO incompatible? |
|
Definition
|
|
Term
| Why is ABO HDFN less severe? |
|
Definition
| fetal antigens are poorly developed |
|
|
Term
| How do you treat ABO HDFN? |
|
Definition
| usually jsut need phototherapy |
|
|
Term
| What should you do for a mother who isABO incompatible with her fetus? |
|
Definition
| nothing; she has already made IgM antibodies, just follow titer levels of antibody |
|
|
Term
| What prenatal screening is performed to protect against HDFN? |
|
Definition
| ABO and Rh (D) typing and antibody screen |
|
|
Term
| If a mother's antibody screen is positive, you should... |
|
Definition
| identify and titer the antibody then follow the titer during pregnancy to see whether it increases |
|
|
Term
| How do you treat a pregnant women who is Rh negative and has not formed anti-D? |
|
Definition
| give 1 dose of Rhogam IM at 28 weeks GA then another dose within 72 hours of delivery |
|
|
Term
| What test is performed if feto-maternal hemorrhage is suspected? |
|
Definition
| Kleihauer-Betke test to quantify the amount of fetal RBCs in mother's ciruclation. Tells you the amount of RhIg needed to cover the volume of hemorrhage |
|
|
Term
| What do you do for a pregnant women who has already formed anti D? |
|
Definition
| monitor antibody titer throughout pregnancy; if Ab titer >1:16 by 24th week of gestation, amniocentesis is indicated to assess severity of HDN by bilirubin concentrations |
|
|
Term
| How do you treat HDFN prenatally? |
|
Definition
| intrauterine transfusion premature induction of labor or plasmapheresis |
|
|
Term
| How do you treat HDFN in the neonate? |
|
Definition
| phototherapy to conjugate bilirubin or exchange transfusion |
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