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38 Cards in this Set

  • Front
  • Back
What is the most common form of organ transplant in the world?
blood transfusion
Acute hemolytic transfusion rxn (AHTR) is typically due to ?
clerical error
AHTR occurs w/in ___ of transfusion.
4 hours
AHTR is due to blood type mismatch, this activates the _____ system, this results in _____ hemolysis.

Signs and symptoms of AHTR:
DIC, oozing from IV site, fever, hemoglobinuria, flank pain, vomiting, diarrhea, hypotension, pain at infusion site, chest tightness, urticaria (allergic rxn), hives
3 Steps if you suspect AHTR:
2) Give fluids and vasopressors to increase BP
3) Collect all tubing and bags for lab, and perform a fresh type and screen of patient (Remember clerical error is MCC or AHTR)
Delayed hemolytic transfusion rxn (DHTR) typically occurs ___ after transfusion.
5 days to 2 weeks
What is the pathophysiology behind DHTR (differentiating it from AHTR)?
no preformed antibodies, but patient has been sensitized to antigens on transfused RBCs

patient has probably been transfused before or pregnant before
DHTR results in ___ hemolysis.
What values are abnormal and are often the only sign of DHTR?

drop in hematocrit or rise in bilirubin
Treatment for DHTR (2)?
1) Supportive
2) Determine antibody causing rxn and avoid administering future RBCs with that particular antigen
Which two types of patients are more susceptible to alloimmunization? Why?
1) patients transfused b/f
2) multiparous women

These two patients are exposed to more foreign antigens on RBCs and therefore have a greater likelihood of activating a previous immune rxn to those antigens.
What is donor directed blood?
family members donate compatible blood to a patient who has expected loss of blood due to surgery
Symptoms of febrile non-hemolytic transfusion rxn (FNHTR)?
shaking chills, fever greater than 38 deg w/in four hours of transfusion, tachycardia, HTN, and cough
What is the pathophysiology behind FNHTR?
CYTOKINE mediated (instead of COMPLEMENT mediated like in AHTR)

rxn of recipient antibody w/ donor leukocytes or platelets OR rxn of donor antibody w/ recipient cells
Treatment for FNHTR?
antipyretics or meperdine
NON-CARDIOGENIC PULMONARY EDEMA due mostly to rxn btwn patient's neutrophils and donor antibodies
Presentation of TRALI
respiratory distress (MC presentation): tachypnea, hypoxia, O2 desat, bilateral infiltrates on CXR
How is TRALI different from ARDS?
patients recover in 3-7 days w/ NO LONG TERM SEQUELAE
TRAIL will occur ____ after transfusion.
6 hours
Steps taken in TRALI:
1) STOP THE TRANSFUSION (notice a trend?)
2) Supportive care
3) Send blood bags, etc. to blood bank
4) Donor gets screened for HLA antibodies, if he/she has them then they can't donate again (sorry)
Allergic rxns stem from _____.
plasma proteins
Who is always at risk for an allergic rxn to blood transfusion?
How should their blood transfusions be treated?
patients w/ IgA deficiencies

an IgA deficient patient will always get washed PRBCs
Explain the pathophysiology behind post-transfusion purpura (PTP)?
multiparous female who has been sensitized to a common platelet antigen by a previous pregnancy

when transfused with platelets w/ that same antigen (HLA-1), the recipient's immune system attacks the donor platelets as well as his/her own platelets causing thrombocytopenia
How does PTP usually present?
a purpuric rash 3 to 10 days after transfusion
What is the key to developing transfusion associated graft versus host disease (TAGVH)?

lymphocytes in donor blood recognize recipient tissue as foreign and attacks it

due to the patient's immunosuppression, they are unable to recognize the foreign WBCs and eliminate them
What organs are most affected by TAGVH?
organs w/ high cell turnover - GI tract, skin, bone marrow, liver

Symptoms follow along those lines - diarrhea (GI), rash (skin), pancytopenia (BM), abnormal LFTs (liver)
How is TAGVH prevented?
gamma irradiation
What is TACO?
a yummy Mexican dish

no, silly, it's circulatory overload seen w/ large units of transfusions that are transfused very quickly

typically seen in an older, more debilitated patient

leads to pulmonary edema
In what type of patients is iron overload a problem?
sickle cell patients have chronic anemia not due to blood loss.... after transfusion iron can get overloaded and deposit in heart, liver, pancreas, and skin

requires chelation therapy
What are 5 consequences of a massive transfusion (10 units or 1 blood volume)?
1) hypothermia (stored blood is cold)
2) citrate toxicity leading to hypocalcemia
3) hypomagnesmia (i'm assuming due to same mechanism as hypocalcemia)
4) hyperkalemia (leaky RBCs)
5) Dilution of clotting factors and platelets
What serologic tests are performed on donated blood?
Hep B, C, and HIV, HTLV, and syphillis

Nucleic acid amplification for HIV, Hep C, and WNV
What is the current risk of transmission of HIV from blood transfusion?
1 in 2 million
How is Hep A screened for in blood donors?
BY HISTORY ONLY, no serologic screening
What is the first serology that becomes positive after infection w/ Hep B?
HBsAg - as acute infection clears, HBsAg drops
What is meant by the window in serologic testing for Hep B?
After 6 months of infection, the HBsAG disappears, the antibody to HBsAg (Anti HBsAg)doesn't appear for a few weeks

you must test for anti-HBeAg and anti-HBcAg so that you do not miss an possible Hep B infection
What will be positive if you have received the Hep B vaccine?
only anti-HBsAg
What is the significance of HbeAG?
appears shortly after HBsAg and implies high infectivity, as the body clears the infection, HBeAg disappears and implies recovery
Where is HBcAg found? What does it imply?
only in hepatocytes

previous infection