Blood Bank Ch 11

Front 1

adverse transfusion reaction

Back 1

an undesirable response or effect in a patient temporarily associated with the administration of blood or blood component

Front 2

Hemovigilance model

Back 2

tracks and analyzes adverse transfusion reactions

Front 3

clinical signs indicative of a transfusion reaction

Back 3

fever >1 C increase or >38C

chills an rigors

respiratory distress: wheezing, coughing, dyspnea, cyanosis

hypertension or hypotension

pain: abdominal, chest, flank or back, infusion site.

skin Manifestations: urticaria, rash, flushing, edema.

jaundice or hemoglobinuria

nausea or vomiting

abnormal bleeding

oliguria or anuria

Front 4

acute hemolytic transfusion reaction.

Back 4

the rapid destruction of red cells during, immediatley after, or within 24 hours after a transfusion of red cells.

signs range in severity from fever to death

usually due to ABO incompatibility

as little as 10 ml of incompatible blood can produce symptoms.

Front 5

signs and symptoms of acute hemolytic transfusion reaction

Back 5

clinical presentation of an AHTR ranges in severity from fever to death.

fever

chills

pain or oozing at the infusion site

back or flank pain

hypotension

epitaxis (nosebleed)

hemoglobinuria

disseminated intravascular coagulation DIC

oliguria

anuria

renal failure

Front 6

AHTR immune mediated

Back 6

hemolytic

febrile, nonhemolytic

allergic

TRALI (transfusion related acute lung injury)

Front 7

AHTR non-immune mediated

Back 7

sepsis

TACO (transfusion associated circulatory overload)

physical hemolysis

Front 8

delayed hemolytic transfusion reaction

Back 8

symptoms appear after 24 hours.

caused by secondary immune response.

less severe than AHTR

usually due to IgG antibodies formed from prior exposure to RBC's through previous transfusion or pregnancy.

antibodies may be undetected during pretransfusion testing due to low titers.

common antibodies: Rh, Kidd, Duffy, Kell, MNS

Front 9

DHTR immune mediated

Back 9

hemolytic

serologic: RBC

HLA alloimmunization

TA-GVHD

posttransfusion purpura

Front 10

DHTR non immune mediated.

Back 10

hemosiderosis

citrate toxicity

Front 11

pathophysiology of AHTR

Back 11

antibody binds to incompatible RBC antigens

complement is activated (mostly IgM, which causes intravascular hemolysis)

phagocytes are activated and release cytokines

coagulation is activated (DIC)

shock and renal failure

Front 12

errors known to cause AHTR

Back 12

collection of blood from the incorrect patient.

incorrect labeling of blood samples

misidentification of sample at blood bank

issuance of wrong unit from blood bank

transfusion of blood to incorrect patient

aliquoting a patient sample to improperly labeled test tube.

Front 13

contributing factors causing errors

Back 13

insufficient segregation of units

preprinted sample lables

patients with similar or identical names

sequential patient identifiers

verbal and STAT orders

manual issuance of blood

simultaneous processing of specimens from multiple patients

tested the correct sample but recorded results on the wrong patinet record.

overriding computer error messages

Front 14

clinical signs and symptoms of AHTR

Back 14

immediate of within 24 hours posttransfusion.

fever,chills, flushing, pain at site of infusion, tachycardia, tachypnea, lower back pain.

hemoglobinemia, hemoglobinuria, hypotension.

Front 15

clinical signs and symptoms of DHTR

Back 15

> 24 hours to 28 days posttransfusion.

fever: temp increase >1C with or without chills.

unexplainable decrease in hemoglobin and hematocrit.

jaundice and hemoglobinuria.

Front 16

major complications of DHTR

Back 16

anemia

Front 17

causes of AHTR

Back 17

ABO incompatibility, complement activation

Front 18

major complications of AHTR

Back 18

DIC

renal failure

shock

mortality

Front 19

causes of DHTR

Back 19

anamnesetic response to red cell antigen

alloantibody not demonstrating or missed pretransfusion

Front 20

clinical lab tests for AHTR

Back 20

clerical check an visual inspection of posttranfusion sample.

DAT: positive or negative.

repeat ABO testing

tests for hemolysis: increased plasma free hemoglobin, incresed serum bilirubin, decreased haptoglobin, hemoglobinuria.

Front 21

clinical lab tests for DHTR

Back 21

DAT: pos.

posttransfusion antibody screen: positive

dereased hemoglobin an hematocrit.

tests for hemolysis: increased plasma free hemoglin, increased serum bilirubin, decreased haptoglobin, hemoglobinuria.

Front 22

management of AHTR

Back 22

treat hypotension and DIC.

maintain renal blood flow.

Front 23

management of DHTR

Back 23

identify antibodies.

provide antigen-negative donor units.

Front 24

prevention of AHTR

Back 24

avoid clerical misidentification errorrs

design systems to decrease chances of technical error.

Front 25

prevention of DHTR

Back 25

check of patient records

recentl transfused or pregnant have sample drawn within 3 days of transfusion.

Front 26

non immune hemolytic anemia.

Back 26

RBC destruction when antibodies are not implicated.

Front 27

causes of nonimmune hemolytic anemia

Back 27

exposure of RBCs to extreme temp

improper deglycerlization

mechanical destruction of RBC's

incompatible soutions: use only physiologic saline.

bacterially contaminaed blood products

intrinsic RBC defects (sickle cell)

Front 28

Febrile nonhemolytic reaction clinical signs and symptoms

Back 28

fever, temp increase >1C above 37C

other symptoms include chills, rigors, headache and vomiting.

Front 29

Febrile nonhemolytic reaction major complications

Back 29

non threatening

significant discomfort to the reciepient.

Front 30

Febrile nonhemolytic reaction causes

Back 30

antibody to donor WBCs

cytokines released by WBCs during blood product storage.

Front 31

Febrile nonhemolytic reaction clinical lab tests

Back 31

DAT: negative

no visible hemolysis

Front 32

Febrile nonhemolytic reaction management

Back 32

antipyretics:acetaminophen

Front 33

Febrile nonhemolytic reaction prevention

Back 33

prestorage leukocyte reduction of blood products.

Front 34

allergic reactions

Back 34

caused by soluble allergens in donor plasma

allergic reaction: IgE reacts with plasma proteins

anaphylactic reactioon: recipient forms antibodies to IgA

symptoms usually occur within seconds to minutes of being transfused.

Front 35

allergic reactions Urticarial clinical signs an symptoms

Back 35

hives an itching within 15-25 min of transfusion

Front 36

allergic reactions Urticarial major complications

Back 36

none

Front 37

allergic reactions Urticarial causes

Back 37

reciepient antibodies to foreign plasma proteins or other substances such as drugs or food consumed by blood donor.

Front 38

allergic reactions Urticarial clinical lab tests.

Back 38

DAT: negative.

no visible hemolysis.

Front 39

allergic reactions Urticarial management

Back 39

transfusion interrupted.

antihistamine administered.

Front 40

allergic reactions Urticarial prevention

Back 40

premedication with antihistamine, if patient history reveals repititive reactions.

may necessitate washed cellular products.

Front 41

allergic transfusion reaction anaphylactic clinical signs and symptoms.

Back 41

rapid onset and severe wheezing, coughing, dyspnea, brnochospasm, respiratory distress, vascular instability.

no fever.

Front 42

allergic transfusion reaction anaphylactic major complications.

Back 42

shock

loss of consciousness

mortality

Front 43

allergic transfusion reaction anaphylactic causes

Back 43

associated with genetic IgA deficiency in recipient who possesses IgG complement-binding anti-IgA antibodies.

Front 44

allergic transfusion reaction anaphylactic clinical lab tests

Back 44

DAT: negative.

no visible hemolysis

perform IgA antigen and anti-IgA resting.

Front 45

allergic transfusion reaction anaphylactic management

Back 45

transfusing terminated

epinephrine and similar drugs administered.

oxygen administered an open airways maintained.

Front 46

allergic transfusion reaction anaphylactic prevention

Back 46

plasma-containing products from IgA-deficient donors.

washed red cell an platelet products.

Front 47

Transfusion-related acute lung injury clinical signs and symptoms

Back 47

fever

chills

hypoxia

dyspnea (shortness of breath)

cyanosis

nonproductive cough

new onset bilateral pulmonary edema

hypotension

acute onset within 6 hour or blood transfusion

Front 48

Transfusion-related acute lung injury major complications

Back 48

severe and dramatic presentation

can be fatal

Front 49

Transfusion-related acute lung injury causes

Back 49

interaction of recipient related risks and transfusion event.

donor with pregnancy history, anti-HLA, anti-HNA

Front 50

Transfusion-related acute lung injury clinical lab tests

Back 50

DAT:negative.

no visible hemolysis

WBC antibody screen in donor and recipient

chest x ray

Front 51

Transfusion-related acute lung injury management

Back 51

respiratory support.

Front 52

Transfusion-related acute lung injury prevention

Back 52

avoid use of plasma components from multiparous women who have HLA antibodies.

Front 53

transfusion associated graft versus host disease clinical signs and symptoms

Back 53

onset 3-30 days posttransfusion.

fever, erythematous maculopapular rash, abnormal liver function, diarrhea, pancytopenia.

Front 54

transfusion associated graft versus host disease major complications

Back 54

marrow aplasia and hemorrhage

90% mortality rate.

Front 55

transfusion associated graft versus host disease cause

Back 55

transfused immunocompetent T lymphocytes mount immunologic response against reciepient.

Front 56

transfusion associated graft versus host disease clnical lab tests

Back 56

confirmation by HLA typing to demonstrate a disparity between donor lymphocytes an recipient tissues.

Front 57

transfusion associated graft versus host disease management

Back 57

unresponsive to medical intervention

Front 58

transfusion associated graft versus host disease prevention

Back 58

irradiation of blood products before transfusion in at-risk recipients.

gamma irradiation (25Gy) to prevent blast transformation of donor lymphocytes.

Front 59

indications for irradiated components

Back 59

intrauterine transfusions

premature, low birth weight infants

congenital immunodeficiencies

hemotologic malignancies

HLA matched components

directed donations from related donors

granulocyte components

newborns with erythroblstosis fetalis.

Front 60

not indicated for irradiated components.

Back 60

patients with HIV

full term infants

nonimmunocompromised patients.

Front 61

Bacterial contamination major sources

Back 61

transient bacteremia in donor.

improper cleansing of the donors skin during collection.

Front 62

bacterial contamination known organisms that can grow upon storage.

Back 62

yersinia enterocolitica (4C)

Serratia liquefaciens ( 4C)

Pseudomonas fluorescens ( 4C)

staph (platelets 20-24C)

Bacillus cereus (platelets 20-24C)

apheresis platelets a platelet concentrates must be tested for bacteria.

Front 63

TACO: transfusion associated circulatory overload.

Back 63

patients cardiopulmonary system exceeds it volume capacity.

candidates susceptible to circulatory overload should receive RBC units.

Front 64

TACO symptoms

Back 64

signs of congestive heart failure.

dyspnea

severe headache.

peripheral edema

Front 65

TACO treatment

Back 65

oxygen therapy an diuretics

Front 66

hemosiderosis

Back 66

accumulation of excess iron in macrohpages in tissues.

usually occurs in patients undergoing long term transfusion (thalassemia)

inron intake exceeds daily iron excretion.

Front 67

hemosiderosis prevention

Back 67

incolves iron chelation.

deferiprone

deferoxamine.

Front 68

citrate toxicicty

Back 68

occurs when large quantities or citrated blood are transfused.

Front 69

citrate toxicity may have adverse affect in

Back 69

those recieving large volumes of blood.

patients with impaired liver function

preterm infants with hepatic or renal insufficiency.

Front 70

citrate toxicity prevention

Back 70

remove plasma that may contain citrate.

inject calcium chloride or calcium gluconae.

Front 71

Posttransfusion purpura

Back 71

women negative for platelet antigen P1A1 are sensitized through multiple pregnancies (produce anti-P1A1 antibody)

platelet count decreases 5-12 days after transfuison

purpura and bleeding follow.

Front 72

treatment of posttransfusion purpura

Back 72

plasmapheresis, exchange transfusion, an intravenoug IgG

Front 73

procedure for adverse reactions (instrucitons to medical staff)

Back 73

stop the transfusion

keep IV open with saline

perform clerical check for ID errors

contact treating physician

monitor/record vital signs

contact trasfusion service

collect postsample an return with blood bag and attached IV fluids to the lab.

Front 74

postreaction workup

Back 74

clerical check: ID errors?

visula check: hemolysis or icteric?

DAT

Front 75

Additional testing in a transfusion reaction investigation: ABO/D phenotyping.

Back 75

errors in patient or sample ID

Front 76

Additional testing in a transfusion reaction investigation: antibody screen

Back 76

newly detected antibodies

Front 77

Additional testing in a transfusion reaction investigation: crossmatch

Back 77

seroligic compatibility

Front 78

Additional testing in a transfusion reaction investigation: hemoglobin/ hematocrit

Back 78

therapeutic effectiveness.

Front 79

Additional testing in a transfusion reaction investigation: haptoglobin

Back 79

hemolytic process

Front 80

Additional testing in a transfusion reaction investigation: bilirubin

Back 80

hemolytic process

Front 81

Additional testing in a transfusion reaction investigation: urine hemoglobin

Back 81

hemolytic process.

Front 82

Additional testing in a transfusion reaction investigation: inspection of donor unit

Back 82

nonimmune hemolysis or bacterial contamination

Front 83

Additional testing in a transfusion reaction investigation: gram stain an blood culture.

Back 83

bacterial contamination

Front 84

case definition criteria for hemovigilance reporting: signs and symptoms

Back 84

Definitive: conclusive

Probable: evidence in favor

possible: evidence indeterminate

Front 85

case definition criteria for hemovigilance reporting: lab/radiology

Back 85

defnitive: conclusive.

probable: evidence in favor

possible: evidence indeterminate.

Front 86

case definition criteria for hemovigilance reporting: severity (graded)

Back 86

Grade 1: nonsevere

Grade 2: severe - requires medical intervention or prolongation of hospitalization or both.

Grade 3: life-threatening; major intervention needed to prevent death.

Grade 4: death as a result of adverse transfusion reaction .

Front 87

case definition criteria for hemovigilance reporting: relationship to transfusion (imputabillity)

Back 87

definitive: conclusive.

probable: evidence in favor

possible: evidence indeterminate.

Front 88

records and reports

Back 88

records of patients experiencing adverse reactions remain indefinitely in transfusion services.

cases of transfusion-related disease or bacterial contamination are reported to the donation facility.

fatalities are reported as soon as possible to the director of the FDA, office of compliance, Center for Biologics Evaluation and Research.