Transfusion And Transplantation

Front 1

What is the main factor in transfusion reactions?

Back 1

1. ABOD incompatibilities

Front 2

What is the main factor in transplant rejections?

Back 2

1. HLA

Front 3

What do you get in a transfusion?

Back 3

1. RBCs sans plasma

Front 4

What is the expression of the ABO genes?

Back 4

1. A and B are codominant

2. O is not expressed

Front 5

What is the precursor to A and B carbohydrates?

Back 5

1. H substance

Front 6

What is Bombay type blood?

Back 6

1. Individuals who make antibodies to H substance

Front 7

What encodes the Rh antigens?

Back 7

1. C, D, and E genes

Front 8

What factor is responsible for most cases of HDNB?

Back 8

1. D antigen

Front 9

What is the universal donor? Universal recipient?

Back 9

1. Donor-- O-

2. Recipient-- AB+

Front 10

What is the MCC of hemolytic reactions?

Back 10

1. ABO**

2. Usually from clerical error

Front 11

What is the presentation of a hemolytic reaction?

Back 11

1. Fever, chills

2. Hypotension

3. Flank or back pain

4. Bloody urine

Front 12

What type of HSR is a hemolytic rxn?

Back 12

1. Type II

2. Complement-mediated intravascular hemolysis

Front 13

How do you tx hemolytic reactions?

Back 13

1. Stop transfusion

2. Check labels

3. IV fluids and diuretics

4. Dopamine

Front 14

What causes febrile reactions in transfusion reactions?

Back 14

1. Abs to mismatched minor blood group antigens

2. Arise after repeated transfusions

3. Temp increase 2 F

Front 15

What causes allergic/anaphylactic reactions?

Back 15

1. IgE to donor plasma proteins, including IgA

Front 16

What is the presentation of transfusion allergic/anaphylactic reactions?

Back 16

1. Mild urticaria to anaphylactic shock

Front 17

How do you tx transfusion allergic/anaphylactic reactions?

Back 17

1. Mild--- antihistamines

2. Anaphylaxis--- Antihistamines and steroids, epi for severe

Front 18

Donor cells+recipient serum=agglutination---?

Back 18

1. Recipient has IgM to donor ABO antigens

2. Do not perform transfusion

Front 19

Donor cells+recipient serum+anti-human IgG (coombs)= agglutination---?

Back 19

1. Recipient ahs IgG to donor ABO antigens

2. Do not perform transfusion

Front 20

What is the location of the locus that codes for HLA?

Back 20

1. Chromosome 6

Front 21

What is the cellular basis of graft rejection?

Back 21

1. Recipient's T cells respond to donor dendritic cells rich in HLA I and II

Front 22

What is a hyperacute rejection?

Back 22

1. Minutes to hours

2. Preformed ABO antibodies

3. Graft always lost

4. No tx

Front 23

What is an acute rejection?

Back 23

1. Days to weeks

2. T cell mediated

3. Immunosuppressive tx is effective

Front 24

What is a chronic injection?

Back 24

1. Months to years

2. Types III and IV HSR

3. Return of original problem

4. No tx

Front 25

What type of HSR is a hyperacute rejection?

Back 25

1. II

Front 26

What type of HSR is acute rejection?

Back 26

1. IV-- mediated by CD8 Tc cells

Front 27

What are the signs of acute rejection?

Back 27

1. Rapid decrease in renal function +

2. Enlargement and tenderness of graft

3. Lowered urine output

4. Decreased renal blood flow

Front 28

How do you inhibit acute rejection?

Back 28

1. Corticosteroids

2. Cyclosporine

Front 29

What type of HSR is chronic rejection?

Back 29

1. III-- Ab + complement cause vasculitis

2. IV-- TH1-->IFNy-->fibroblasts occlude lumen, macrophages produce enzymes, ROS, TNFa

3. IV-- TH2--> IL-5-- eosinophils

4. IV-- TH17-->IL-17--> PMN infiltration

Front 30

What test is used to evaluate HLA typing?

Back 30

1. PCR

Front 31

For what type of transplant is HLA absolutely essential?

Back 31

1. Bone marrow

Front 32

What is induction tx?

Back 32

1. Suppression about 2 weeks before transplantation to reduce immediate reaction

Front 33

What is maintenance tx?

Back 33

1. Low-dose combination tx to suppress rejection while allowing some immune function to return

Front 34

What is specific tx?

Back 34

1. High dose--- similar to induction tx

2. Manage episodes of acute rejection occurring months or years after transplantation

Front 35

What is the use of hematopoietic stem cell transplantation (HCT)?

Back 35

1. Tx SCID, WAS, leukemia, thalassemia, and sickle cell disease

2. Provides functional stem cells that can differentiate into myeloid/lymphoid cells

Front 36

What is taking the place of bone marrow transplants?

Back 36

1. Peripheral stem cell transplants

Front 37

What is the harvest protocol for peripheral stem cells?

Back 37

1. Donor given G-CSF to promote PMN production

2. Neutrophils make proteases that cleave CD34

3. Stem cells released into circulation where they can be harvested

Front 38

What is autologous HCT?

Back 38

1. Remove cancer cells

2. Cryopreserved

3. patient tx with radiation and/or chemo to kill cancer cells

4. Patient is reconstituted

Front 39

What is allogenic HCT?

Back 39

1. Stem cells harvested from donor and tx with ATG to remove mature T cells-- prevents GVHD

2. Patient is rated with induction tx to kill mature T cells--- prevents graft rejection

3. Patient reconstituted with allogenic stem cells

Front 40

What are the ssx of GVHD?

Back 40

1. Enlargement of spleen, liver, and lymph nodes

2. Skin rash

3. Severe diarrhea and weight loss

4. Autoimmune hemolytic anemia