Adverse Effects Of Transfusion Therapy I

Front 1

What is the most common form of organ transplant in the world?

Back 1

blood transfusion

Front 2

Acute hemolytic transfusion rxn (AHTR) is typically due to ?

Back 2

clerical error

Front 3

AHTR occurs w/in ___ of transfusion.

Back 3

4 hours

Front 4

AHTR is due to blood type mismatch, this activates the _____ system, this results in _____ hemolysis.

Back 4

complement

intravascular

Front 5

Signs and symptoms of AHTR:

Back 5

DIC, oozing from IV site, fever, hemoglobinuria, flank pain, vomiting, diarrhea, hypotension, pain at infusion site, chest tightness, urticaria (allergic rxn), hives

Front 6

3 Steps if you suspect AHTR:

Back 6

1) STOP THE TRANSFUSION (duh)
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)

Front 7

Delayed hemolytic transfusion rxn (DHTR) typically occurs ___ after transfusion.

Back 7

5 days to 2 weeks

Front 8

What is the pathophysiology behind DHTR (differentiating it from AHTR)?

Back 8

no preformed antibodies, but patient has been sensitized to antigens on transfused RBCs

patient has probably been transfused before or pregnant before

Front 9

DHTR results in ___ hemolysis.
What values are abnormal and are often the only sign of DHTR?

Back 9

extravascular

drop in hematocrit or rise in bilirubin

Front 10

Treatment for DHTR (2)?

Back 10

1) Supportive
2) Determine antibody causing rxn and avoid administering future RBCs with that particular antigen

Front 11

Which two types of patients are more susceptible to alloimmunization? Why?

Back 11

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.

Front 12

What is donor directed blood?

Back 12

family members donate compatible blood to a patient who has expected loss of blood due to surgery

Front 13

Symptoms of febrile non-hemolytic transfusion rxn (FNHTR)?

Back 13

shaking chills, fever greater than 38 deg w/in four hours of transfusion, tachycardia, HTN, and cough

Front 14

What is the pathophysiology behind FNHTR?

Back 14

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

Front 15

Treatment for FNHTR?

Back 15

antipyretics or meperdine

Front 16

NON-CARDIOGENIC PULMONARY EDEMA due mostly to rxn btwn patient's neutrophils and donor antibodies

Back 16

TRALI

Front 17

Presentation of TRALI

Back 17

respiratory distress (MC presentation): tachypnea, hypoxia, O2 desat, bilateral infiltrates on CXR

Front 18

How is TRALI different from ARDS?

Back 18

patients recover in 3-7 days w/ NO LONG TERM SEQUELAE

Front 19

TRAIL will occur ____ after transfusion.

Back 19

6 hours

Front 20

Steps taken in TRALI:

Back 20

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)

Front 21

Allergic rxns stem from _____.

Back 21

plasma proteins

Front 22

Who is always at risk for an allergic rxn to blood transfusion?
How should their blood transfusions be treated?

Back 22

patients w/ IgA deficiencies

an IgA deficient patient will always get washed PRBCs

Front 23

Explain the pathophysiology behind post-transfusion purpura (PTP)?

Back 23

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

Front 24

How does PTP usually present?

Back 24

a purpuric rash 3 to 10 days after transfusion

Front 25

What is the key to developing transfusion associated graft versus host disease (TAGVH)?

Back 25

immunosuppression

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

Front 26

What organs are most affected by TAGVH?

Back 26

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)

Front 27

How is TAGVH prevented?

Back 27

gamma irradiation

Front 28

What is TACO?

Back 28

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

Front 29

In what type of patients is iron overload a problem?

Back 29

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

Front 30

What are 5 consequences of a massive transfusion (10 units or 1 blood volume)?

Back 30

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

Front 31

What serologic tests are performed on donated blood?

Back 31

Hep B, C, and HIV, HTLV, and syphillis

Nucleic acid amplification for HIV, Hep C, and WNV

Front 32

What is the current risk of transmission of HIV from blood transfusion?

Back 32

1 in 2 million

Front 33

How is Hep A screened for in blood donors?

Back 33

BY HISTORY ONLY, no serologic screening

Front 34

What is the first serology that becomes positive after infection w/ Hep B?

Back 34

HBsAg - as acute infection clears, HBsAg drops

Front 35

What is meant by the window in serologic testing for Hep B?

Back 35

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

Front 36

What will be positive if you have received the Hep B vaccine?

Back 36

only anti-HBsAg

Front 37

What is the significance of HbeAG?

Back 37

appears shortly after HBsAg and implies high infectivity, as the body clears the infection, HBeAg disappears and implies recovery

Front 38

Where is HBcAg found? What does it imply?

Back 38

only in hepatocytes

previous infection