Immunohematology Spring Term

Front 1

Blood Donation
1.Age
2.Interval time between donations RBC?
3.Plasma?
4.Should weigh at least?
5.Blood pressure?
6.HCT of:
7. Temperature:___

Back 1

a) Age 17 and up
b) Interval between donation 8 weeks (RBC)
c) Interval between donation 48 hrs (plasma, pph)
d) Should weigh at least 110 lbs.
e) Pulse 50-100
f) Blood pressure
i) <180 systolic
ii) <100 diastolic
g) HCT 38 or more
h) Temperature <or = to 37.5

Front 2

Travel Deferral
a.Aimed at CJD prevention, what country and from what year to what year?
b.Areas with malarial risk, ___ months in Cancun, ___ months if taking meds.
c.Permanent deferral Exposures from_____(list all countries)_____

Back 2

a) Europe
i) 1980 – 1996
(1) 6 months in England

b) Areas with malarial risk
3 mo: jeep ride to Cancun
12 mo if taking meds
c) Permanent Deferral Exposures
i) Sub-Saharan Africa (Cameroon, Central African Republic, Chad, Congo,Equatorial Guinea, Gabon, Niger, Nigeria)
(1) Sexual contacts and people from here indefinitely deferred

Front 3

Health Deferrals
a. Dental work
b.Recent surgery
c.Transfusion
d. Pregnancy
f. Chest pain, heart disease, seizuress
g.Vaccinations
h.Chagas, babesios, malaria :defer or not defer

Back 3

3) Health Deferrals
a) Recent dental work –3 days •
b) Recent surgery -6 weeks
c) Transfusion –1 yr
d) Pregnancy -6 weeks
e) Chest pain, heart disease, seizures –defer if active
f) Vaccinations
i) Killed vaccines 2 months
ii) Live vaccines 12 months
g) Cancer –permanent
h) Chagas, babesiosis, malaria-permanent

Front 4

Health Deferral
i. Medications
i.Acutane
ii.Tegison
iii.Aspirin
j. Miscellaneous deferrals
i.Transfusion
ii.Pregnancy
iii.Exposure to persons with (5 answers)?

Back 4

i) Medications –Complicated; lists available
i) Acutane, proscar–1 month off drugs
ii) Tegison-permanent
iii) Aspirin 3d for platelet donors
j) Miscellaneous deferrals
i) Transfusion –12 months
ii) Pregnancy –6 weeks
iii) Exposure to persons with Hepatitis, HIV, other STD, prison, sex with prostitute 12 months

Front 5

Permanent Deferrals
i.5 categories that would result in permanent deferral
j. Temporary deferrals (12 months)
3 situations for temp deferrals

Back 5

i) Permanent Deferrals
(1) Viral hepatitis after 11th birthday
(2) Has or had confirmed positive HBsAg
(3) Repeat reactive to HBcAb •Present or past evidence of HCV
(4) Self injected drugs
(5) Sole donor involved in Post-donation Hepatitis
ii) Temporary Deferrals (12 months)
(1) Close contact with Hepatitis–Share bathroom, kitchen, household
(2) Blood transfusions, transplants
(3) Tatoos, ear piercing, acupuncture or accidental needlestick

Front 6

Donor Reactions
a.What reactions are considered mild
b.Moderate reactions?
c.Severe reactions?

Back 6

a) Mild Reactions –Nervousness, anxiety, feeling warm, pallor, sweating, etc.
i) Does NOT lose consciousness. –Stop donation!!! Do NOT leave donor!!
b. Moderate Reactions–Previous symptoms PLUS donor loses consciousness.
c. Severe Reactions–
(1) Add convulsions to previous listed symptoms
(2) Nerve injuries
(3) Hematomas

Front 7

Donor Testing
a.3 first tests
b. Transmissible disease testing

Back 7

a) ABO, Rh (Weak D), IAT
b) Transmissible disease testing:
i) HIV I & II
(1) Anti-HIV I & II antibodies, HIV NAT
ii) Hepatitis B and C
(1) HBsAg, anti-HbC antibodies, Anti-HC antibodies, HC NAT
iii) HTLV I/II –West Nile Virus
(1) Anti-HTLV I & II antibodies
iv) Syphilis
(1) RPR
v) Bacteria (platelets only)(1)By culture
vi) West Nile Virus
(1)WNV NAT
vii) Chagas disease (1) Chagas NAT

Front 8

Anticoagulant/Preservative
a.Basic ingredients
b.CPDA-1
i.___days storage
ii. used for?
c.AS-1
i.___days storage
ii.type of preservatives

Back 8

a) Basic ingredients
i) Citrate: Anticoagulant (binds calcium)
ii) Sodium Biphosphate: Buffers pH
iii) Dextrose: Supports ATP generation
iv) Adenine: Provides substrate for ATP generation
b) CPDA-1:
i) Allows 35 day RBC/Whole Blood storage
ii) Mostly used now for Autologous Whole Blood Units
c) AS-1
i) Allows 42 day storage
ii) Preservative anticoagulant most commonly used for RBCs
(1) Packed RBC + negligible amounts of plasma, some mannitol

Front 9

Storage Details for Various Blood Products
Product:
1.a.PRBCs
b.Whole blood
2.Frozen RBC
3.Washed RBC
4.Platelets
5.WBCs
6. Fresh Frozen Plasma
7.Cryoprecipitate

Back 9

Storage Details for Various Blood Products
Product:
1.a.PRBCs:35 days CPDA-1
b.Whole blood :42 days Additives 1-6C
2.Frozen RBC:10 years:-65 degrees; 24 hours after thaw
3.Washed RBC:24 hours 1-6C
4.Platelets:5 days 20-24C gentle agitation
5.WBCs:24 hours 20-24C
6. Fresh Frozen Plasma:1 year:-18C; 7 years:-65C; 24 hours: 1-6C after thaw
7.Cryoprecipitate: 1 year:-18C; 6 hours 20-24C after thaw (4 hours if pooled)

Front 10

Quality control for Blood Products:
1.RBCs
2.RBCs leukoreduced
3.Platelets (PC)
4.Platelets (PC) leukoreduced
5.Apheresis Platelets
6.Apheresis platelets leukoreduced
7. Cryoprecipitate
8.Granulocyte concentrate

Back 10

Quality control for Blood Products:

Front 11

Blood products
a.Whole blood (temp?)
i.___ mls
ii.____ day outdate
iii. Uses

Back 11

Blood Products
a) Whole Blood {WB} (1-60C)
i) 450 -500 ml
ii) 35 day outdate (CPDA-1)
iii) Not available for general use; most donations now fractionated.
(1) Usual form to receive Autologous units
(2) Can have plasma extracted if volume overload a concern

Front 12

b.Packed Red Blood Cells (temp?)
i. ___mls, hematocrit of ___
ii. __ day outdate
iii. Leukoreduced, reduces what?
Blood Products:
iv. Irradiated
1.Why
2.Expiration date:

Back 12

Blood Products:
b) Packed Red Blood Cells {PRBC}(1-60C)
i) 350 ml
(1) Hematocrit 55-60
ii) 42 day outdate (AS1)
iii) Leukoreduced {RC LR}– Most now are LR
(1)Reduces CMV, HLA alloimmunizations, Febrile reactions
iv)Irradiated(1)Eliminates risk of GVHD in BMT and other patients with severe immunodeficiency (2)Expiration date: 28 days (RBCs) from irradiation or original outdate if <28

Front 13

Blood products:
v.Fresh , eliminates what?
vi. Washed,
1.Eliminates what?
2.Used mostly for___

Back 13

Blood Products:
v)Fresh {RC5}(< 5 days old)
(1)Eliminates risk of potassium toxicity in neonates
vi) Washed (1)Eliminates potassium, serum proteins
(2)Used mostly for patients with protein allergies or when RC5 unavailable

Front 14

Blood Products:
Frozen, Deglycerolized Red Cells (temp?)
i.Must be frozen ___ and placed in freezer within___ adding____
ii.___ year outdate frozen
iii.Open system for ___;stored at _____and use within ____ hours after washing
iv.Generally used for ____
v.low _____ levels

Back 14

c) Frozen, Deglycerolized Red Cells {DG} (-650C or cooler)
i) Must be frozen within 6 days and placed in freezer within 4 hours adding glycerol
ii) 10 year outdate frozen
iii) Open system for wash; stored at 1-60C & used with 24 hours of washing.
iv) Generally used for rare donor banks needed to support patients with single or multiple antibodies reactive with high percentage of donors
v) Low potassium levels

Front 15

Plasma, Frozen (temp?)
1.FFP if frozen within ____ hours of collection
2.FP if frozen within ____ hours of collection
i.___mls
ii.___ year outdate at -18C
iii. After thaw, stored at 1-6 degrees Celcius and use within ____ 24 hours.
iv. volume
v.Contents

Back 15

Blood Products
Plasma, Frozen {FP, FFP} (-180C or colder)
(1) Fresh frozen plasma{FFP} if frozen within 8 hours of collection
(2) Frozen plasma {FP} if frozen within 24 hours of collection
i) 250 ml
ii) 1 year outdate @-18
iii) After thaw, stored at 1-60C & used with 24 hours*
iv. 200 - 250 mls
v. Contents: All coag factors: 400 mg fibrinogen, 1 IU/ml of all others. Almost no viable cells.

Front 16

Blood Products
I.Thawed Plasma
a. Modified from ____
b. Lower factors _____
II. Plasma, Cryo-reduced
i.left over after removal of___
ii.Storage and outdates
iii. Used to treat ____

Back 16

I.Thawed Plasma {TP%}
(a) Modified from FP to extend outdate to 5 days (reduces wastage)
(b) Lower factor V and VIII, otherwise used same as FP
II. Plasma, Cryo-reduced {FP-CR}
i)Plasma left over after removal of cryoprecipitate
ii)Same storage and outdates as FP
iii)Used to treat TTP that does not respond to pheresis with FP

Front 17

Cryoprecipitate
i.1 year outdate at what temp
ii.Once thawed stored at 20-24C and use within____ hours.
iii.Volume?
2.Pooled precipitate
i.___ units of cryo mixed in open system, ___ ml
ii. 1 year outdate at ___ C
iii.Once thawed, stored at 20-24C, use after ___ hours

Back 17

1.Cryoprecipitate {Cryo}
i)1 year outdate @-18
ii)Once thawed, stored at 20-240C, & used within 24 hours
iii. approximately 15mls
2.Pooled Cryoprecipitate {Cryo-Pool}
i)4 units cryo mixed in open system, 40-50 ml
ii)1 year outdate @-18
iii)Once thawed, stored at 20-240C, & used within 4 hours
i)Platelets, Apheresis {PPH} (20-240C with agitation)
i)5 day outdate
ii)Cultured for bacteria

Front 18

1.Platelet Apheresis
i. ___ day outdate
ii.cultured for ___
iii. Volume?
2.Platelets, Random Donor
i.__ day outdate
ii.usage
3.Granulocytes (temp)
i.___ hour outdate
ii.Due to high RBC contamination what must tech do.
iii.Mandatory ______
iv. Leukoreduced?
v.clinical effectiveness

Back 18

1.Platelets, Apheresis {PPH} (20-240C with agitation)
i)5 day outdate
ii)Cultured for bacteria
2.Platelets, Random Donor
i)5 day outdate
ii)Cheaper, but not used much anymore.
3.Granulocytes (20-240C)
a)24 hour outdate
b)Must be RBC crossmatched against recipient plasma
c)Irradiation mandatory
d)Never leukoreduced!
e)Not used much because of limited clinical effectiveness

Front 19

RBC component Storage Lesion
1.Definition
2.Decreased in :
3.Increased in

Back 19

RBC component storage lesion
1. The biochemical changes that occur during storage of RBC components
2. Decreased 2,3-DPG (left shifted oxygen-hemoglobin dissociation curve), ATP, pH
3.Increased K+

Front 20

RBC: Dose and indications
a)Standard dose ______
i)Should bump hematocrit by 6
b)Symptomatic anemia , list examples
c)At risk for ischemia and hematocrit___
d)Active bleeding with a blood loss ___ or more of estimated blood volume, and hematocrit___
e)Non-bleeding patient with a hematocrit ____
f)Acute myocardial infarct and hematocrit___
g)Chronic transfusions to suppress endogenous hemoglobin production in selected patients with _________ and _______.

Back 20

a.2 units
i hematocrit by 6
b)tachycardia, tachypneas, no exercise tolerance, etc)
c)At risk for ischemia and hematocrit <28%
d)Active bleeding with a blood loss 15% or more of estimated blood volume, and hematocrit <30%
e)Non-bleeding patient with a hematocrit <24%
f)Acute myocardial infarct and hematocrit <35%
g)sickle cell or thalassemia syndromes

Front 21

Platelet: Usual dose and indications
a)Standard dose___
i)Should bump count______
b)Platelet count <5,000-10,000 in a non-bleeding patient
c)Platelet count <20,000
d)Platelet count <50,000
e) With platelet count <100,000 ?

Back 21

13) Platelet: Usual dose and indications
a)Standard dose 1 unit
i)Should bump count 30-50,000
b)Platelet count <5,000-10,000 in a non-bleeding patient
c)Platelet count <20,000 in a non-bleeding patient with risk factors (sepsis, fever, coagulopathy, etc) •
d)Platelet count <50,000 with impending surgery or invasive procedure •
e)Trauma or major surgery with bleeding or, anticipated CNS and/orocular bleeding, with platelet count <100,000 •

Front 22

Plasma Components Usual dose and Indications
a.STd dose and how much more if pt INR is >2.0
b. PT INR >1.5 and ....
c.PT INR >1.3 and .....
d.Factor deficiencies , what are they
e.Diffuse microvascular studies awaiting ___ and ___
f._______ exchange transfusion

Back 22

Plasma Components Usual dose and indications
a)Std dose 2-3 units; More if INR >2
b)PT INR >1.5and active bleeding, or anticipated major surgery or invasive procedure within 24 hours
c)PT INR >1.3 and with or at risk for CNS Bleed
d)(Protein C, S, factor XI, etc)
e) PT and PTT studies
f)Plasma

Front 23

Cryoprecipitate dose and indications
a.Standard dose
i.should bump fibrinogen by ___
ii.Fibrinogen level of ____ with active bleeding or major surgery, procedure.
iii.________disease unresponsive to DDAVP
iv.in post cardiac surgery, what defect? and what factor deficiency
v.End stage____ disease or uremia unresponsive to DDAVP
vi. ____ glue.

Back 23

a)Standard dose 2 pools (more if fibrinogen <50)
i)Should bump fibrinogen by 50
ii)Fibrinogen level <100 mg/dL
iii)Von Willebrand's diseaseor hemophilia unresponsive
iv)Documented or suspected qualitative platelet defect (post cardiac surgery, etc.) •Factor XIII deficiency
v)Liver disease or uremia unresponsive to DDAVP
vi)Fibrin glue (Fibrin Sealant preferred

Front 24

Massive Transfusion Protocol
a.Replacement of one blood volume in ____
b.What is 1st goal in massive transfusion
c.2nd goal?

Back 24

Massive Transfusion Protocol
a)Replacement of one blood volume in < 24H
i)Equivalent to about 10 U RBC
b)1st goal to maintain adequate blood volume
i)Prompt delivery RBC crucial
(1)Uncrossmatched blood commonly used at start
(2)Usually sent out in boxes of 6
c)2nd goal to monitor and treat coagulation problems before they become clinically significant
i)FP, Platelets, CRYO as needed
(1)4 thawed FP kept on hand

Front 25

Platelet Refractoriness
a.__________causes should be ruled out.
i.examples to rule out
b.Post transfusion increment of_______ help identify immune causes
i.count done within___ hour
ii.Fresh, ____ compatible platelets
c.Big problem in _____ patients
i.worse in ____ pts.
d.Caused by _____ and ____ antibodies
i. best way to identify compatible units
ii.second resort if cant find in Capture P.

Back 25

Platelet refractoriness
a)Non immune causes should be ruled out
i)Sepsis, splenomegaly, drug reactions, TTP
b)Post transfusion increment of < 15,000 help identify immune causes
i)Counts done within 1 hour
ii)Fresh, ABO compatible platelets
c)Big problem in multiply transfused patients
i)In women who’ve been pregnant
d)Caused by anti-platelet and anti-HLA antibodies
i)Capture P platelet XM
ii)HLA matching

Front 26

I. Immune Hemolytic Anemia definition
a.% of antibodies immunity
b._______ specificity very broad, directed at high incidence self antigens
c.Warm autoimmune hemolytic anemia
1.Hard/Easy to find compatible units?
2.Need to rule out underlying ____
a._________if NOT transfused
b._________if transfused
3.Best practice to limit____
a.____ cells are usually destroyed rapidly
b.When transfusion is unavoidable...
c.Inc or Dec risk?

Back 26

Drop in hemoglobin and hematocrit due to antibodies that shorten RBC survival.
a) Immune
Warm antibodies (70%)Cold(18%)Drug related antibodies (2%)
b)Autoantibody specificity
;Anti-e or anti-I fairly common
c)Warm autoimmune hemolytic anemia
(1)Hard (warm auto)
(2)Alloantibody
(a)Autoabsorption
(b)Elution studies
(3) limit transfusion
(a)Transfused cells are usually destroyed as rapidly as the patient’s own cells.
(b)When transfusion is unavoidable, usually must transfuse with least incompatible
(c)“Increased risk”

Front 27

Cold Hemaglutinin Disease
i.Interfere with ____ typing
ii.Idiopathic Cold Agglutinin Syndrome:
iii.Secondary Cold Agglutinin Syndrome:
iv.Paroxysmal Cold Hemoglobinuria:

Back 27

Cold Hemagglutinin Disease
i)ABO typing (cold auto)
ii)Idiopathic
(1)Disease of elderly
(a)Mild, No known cause
(b)Chronic
iii.Secondary
(1)Secondary to Mycoplasma pneumoniae or Infectious Mono
(a)Acute/transient (weeks to months)
iv)Paroxysmal
(1)Hemoglobinuria following exposure to cold
(2)Children after viral illness (mumps,chickenpox, flu

Front 28

Drug Induced Hemolytic Anemia
i.What leads to this immune response
ii.What does the antibodies do?(where do they attach?)
iii.How do antibodies may recognize primarily the drug or primarily the membrane?

Back 28

e) Drug-Induced Immune Hemolytic Anemia's
i) Most drugs are probably capable of binding loosely, or firmly, to circulating cells, which can lead to an immune response.
ii) Antibodies can be formed to the drug itself or to the drug plus membrane components
iii) When an antibody is formed against the combination of the drug and membrane it may recognize primarily the drug or primarily the membrane.

Front 29

Hemolytic Disease of Newborn
i.Definition
1._____ antibodies, is the most mild form
2._____ antibodies, most severe form
i. Anti- ____ is #1 historical cause, still impt.
ii.other anti-___ also important.

Back 29

Hemolytic disease of the Newborn (HDN)
i)Hemolysis of neonatal cells my maternal antibodies
(1)ABO antibodies
(a)Most mild form
(b)Fetus usually OK
(c)Bilirubin can get too high after birth, need treatment
(i)Bili-lights or rarely exchange
(2)Irregular (IGG)Antibodies
(a)Most severe form of HDN.
(i)Anti-D is #1 historical cause, still important
(ii)Anti-K, -Fy(a), -s, etc. also important

Front 30

Pathophysiology of HDN
a.Erythroblastosis fetalis
i.definition
b.Hydrops fetalis
i.Severe cases can lead to
ii.Can also lead to
II.Diagnosis of HDN
a. _____ antibody screen
i. 1st step is...
ii. Perform ___ and which antibody is clinically significant

Back 30

(3) Pathophysiology of HDN
(a)Erythroblastosis fetalis.
(i)Accelerated red cell destruction leads fetus to increase production of & nucleated RBCs
(b)Hydrops fetalis
(i)Severe cases of HDN can result cardiovascular failure and tissue hypoxia, Generalized edema of the fetus
(ii)Can lead to fetal death
II.Diagnosis of HDN
(a)Prenatal Antibody Screen
(i)Identify antibody
(ii)Perform Titration if antibody is clinically significant (anti-D, -K, etc.)

Front 31

Describe Procedure in Performing Titration for HDN

Back 31

Perform Titration if antibody is clinically significant (anti-D, -K, etc.)
1.FREEZE the serum sample
2.If a subsequent titer is requested you need to compare the first titer results with the second tite
3.Run both titers in parallel and compare endpoints.
4.Two tube increase is clinically significant
a.May lead to more invasive testing (Amniocentesis, etc.) to determine severity of disease.
(5)Treatment

Front 32

Treatment of HDN
a._________ transfusion
i. Use what type of cells
b.______ transufusion
i.When?
ii. requirements

Back 32

Treatment of HDN
(a)Intrauterine Transfusion (IUT)
(i)Use type washed O RBC, compatible with mother, irradiated
(b)Exchange Transfusion
(i)Usually after child is born
(ii)Same RBC requirements as above but warm and adjusted to desired hematocrit with plasma

Front 33

Prevention of HDN
a. ____ Globulin
i. Full dose:
1.Sufficient to counteract ____ mls of _____
ii.Mini dose:
1.Sufficient for____
2.Used for....

Back 33

Prevention of HDN

(a)Rh Immune Globulin
(i)Full Dose: 300 micrograms of anti-D
1.Sufficient to counteract 15 mls of D positive packed red cells (~30 mlswhole blood
(ii)Mini dose: 50 micrograms
1.Sufficient for 2.5 mlsD positive blood
2.Used for first trimester abortion or miscarriage.

Front 34

Transfusion Reactions

a.Definition
i. ___ caused by pt ID error
1.give example
ii.___ due to lab error
1.give example

Back 34

Transfusion Reactions

a)Most common causes of fatal transfusion related deaths:
i)2/3 caused by patient identification error
(1) improper specimen identification or improper patient identification
ii)1/3 due to lab error
(1)antibody identification error or crossmatch procedure error

Front 35

Intermediate Transfusion Reactions (Intravascular)
1.Symptoms include ____
2.Signs may include
3.____ is present in circulation
a. Most common cause ____
b.Reaction begins within ___ of infusion
c.Ig___
i. does it activate complement?

Back 35

b) Immediate transfusion reactions
INTRAVASCULAR
(1)Symptoms include fever or fever & chills, burning pain •oliguria •anuria
(2)Signs may include Free Hgb in serum & urine, renal failure, shock, abnormal bleeding
(3)Ab present in circulation
(a)Most common cause ABO incompatible blood
(b)Reaction begins within minutes of infusion
(c)IgM &/or IgG
(i)Complement activating

Front 36

Transfusion Reactions (EXtravascular)
1.Symptoms are:
2.Signs are:
3.If Antibody is present in circulation...
4.Commonly Ig__
a.Does it activate complement
5.Time of reaction
a.Fall in ___ and elevated ____

Back 36

EXTRAVASCULAR
(1)Symptoms fever or fever & chills
(2)Signs jaundice or unexpected anemia
(a)No free Hgbin urine or circulation
(3)If Ab is present in circulation, reaction may begin shortly after infusion
(4)Commonly IgG
(a)May or may not activate C’
(5)May be immediate (hrs) or delayed (days)
(a)Fall in hematocrit and elevated bilirubin

Front 37

Febrile Transfusion Reactions
i.____ type of reactions
ii.Non hemolytic reaction seen in the ff:
iii. Increase or Decrease in temp of 1C or more

Back 37

c) Febrile Transfusion Reactions
i) Most common type of reaction
ii) Non-hemolytic reaction seen in multiply transfused, multiple pregnancies, previously transplanted
iii) INCREASE in temp. of 1OC or more
(1) associated with transfusion
(a) usually “mild & benign”= not life threatening
(b) can have more severe symptoms
(c) Cause–antibodies to leukocyte HLA antigens

Front 38

Allergic(Uticarial) Transfusion Reactions
i. common?
ii.Begins within ____ of transfusion
1.Due to
2.Usually involes release of ___
iii. _____ be sure that the only reactions is the development of uticaria
iv.Can pretreat with ____

Back 38

Allergic (Uticarial) Transfusion Reactions
i)Next most common reaction
ii)Begins within minutes of infusion
(1)Due to antibodies directed against donor proteins
(2)Usually involves release of histamines
iii)MUST be sure that the only reaction is the development of uticaria
iv)Can pre-treat with anti-histamines –OK to treat and continue transfusion if only mild
(1)ONLY trxn where this is OK

Front 39

Anaphylactic transfusion Reaction:
i.common?
ii.Life treatening fall in ____ associated with transfusion
iii.Pt. is _______
iv.Pt. can react to even small amounts of ___
v.Reaction may occur in ____ of beggining transfusion
1.Onset of symptoms is ___
2.What MUST you do next?

Back 39

Anaphylactic transfusion reaction
i.Rare
ii. Blood pressure associated with transfusion
iii.Patient is IgA deficient & has anti-IgA in serum
iv.Pt. can react to even small amounts of IgA in the serum in any component
v.Reaction may occur within minutes of beginning transfusion
(1)Onset of symptoms is SUDDEN
(2)MUST STOP TX’N IMMEDIATELY

Front 40

Non-Cardiogenic Pulmonary Edema (Transfusion Related Acute Lung Injury –TRALI)
i.Severe ____ distress, symptoms.
ii.Causes donor antibodies to ____
iii.Prevention

Back 40

Non-Cardiogenic Pulmonary Edema (Transfusion Related Acute Lung Injury –TRALI)
i)Respiratory –> Chills, fever, cough, hypoxia, cyanosis, hypotension
ii)Cause donor antibodies to host HLA antigens
iii)Prevention:
(1)Eliminate multiparous female donors with antibodies
(a)All male plasma donations
(b)Test for antibodies and defer positive donors

Front 41

Transfusion Reaction Workup (1 of 3 cards)
1.Clerical Check: what are the procedures
2.Specimen check:what are the procedures

Back 41

a) CLERICAL CHECK
i) Correct identification of Spec., Pt. & Tx’d Unit
ii) Agreement of records and history with current results and interpretation of results
iii) Correct labeling of Tx’d Unit
b) SPECIMEN CHECKS
i) Visual inspection of post-transfusion specimen, blood bag and lines
ii) Check of records for hemolysis in pre-transfusion spec
(1) –detectable at 20mg/dL

Front 42

Transfusion reaction workup (2 of 3 cards)
3.Wet Testing
i.ABO
ii.DAT
iii.Repeat Crossmatch
iv.Repeat IAT

Back 42

c) Wet testing
i) ABO grouping
(1) pretransfusion, posttransfusion, segment, & donor unit.
ii) DAT on post-tx’n spec. (DO THIS FIRST)
(1) Positive? Perform eluate and identify antibody if pretransfusion specimen has negative DAT
iii) Repeat CROSSMATCH
(1) Use pre and post specimen and re-check against unit
iv) Repeat IAT
(1) pre-& post-tx’n rx’n
(2) Positive? Identify antibody and compare results of serum & eluate panels

Front 43

Transfusion reaction Workup (3 of 3 cards)
*Special Situations
i.R/O septic Reactions
ii.R/O TRALI

Back 43

Transfusion Reaction Workups *Special Situations
i) R/O Septic Reaction
(1)Recover Product –Gram Stain –Patient and Product Culture –Exclude pre-existing condition
ii) R/O TRALI
(1)Donor history (ID Multips) –Class I & II HLA and anti-neutrophil antibody studies on donors
(2)HLA type of recipient