Exam Iv

Front 1

Hemolysis in Immediate Hemolytic TR?

Back 1

Intravascular hemolysis

Front 2

Cause of IHTR

Back 2

• ABO in compatibility

• Potent Alloantibodies (Anti-Vel and anti-PP1Pk)

Front 3

Is IHTR complement mediated?

Back 3

Yes

Front 4

• Fever with or with out chills (80%)
• Hemoglobinuria and Hemoglobinemia
• Chest, Abdominal and/or back pain
• Pain/warmth at IV site
• SOB
• Tachycardia
• Anxiety
• Olgiuria/with Renal Failure, DIC, Shock

Back 4

IHTR

Front 5

Onset of IHTR

Back 5

acute/immediate

Front 6

DHTR onset

Back 6

at least 24 hours after transfusion usually 2-14 days

Front 7

Cause of DHTR

Back 7

• Donor cells coated with patient Ab and removed by extravascular hemolysis
• Ex: anti-JK, anti-Rh, anti-Fy
• Other alloantibodies

Front 8

Hemolysis in DHTR

Back 8

Extravascular

Front 9

• Fever (increase 1C)
  
• Drop in H&H
• Jaundice (increased bilirubin)

Back 9

DHTR

Front 10

Recommendations for future transfusion in DHTR

Back 10

Ag negative rbcs

Front 11

• Itching hives
• Rash
• Raised Red areas on skin
• Flushing

Back 11

urticarial

Front 12

Cause of urticarial reaction

Back 12

• Patient Ab to donor plasma protein
• Pre-exsisting IgG/IgE or both in patient

Front 13

Recommendations for future transfusion with urticarial reaction

Back 13

• Treat patient with antihistamines prior to transfusion
• Washed red cells/platelet products
• PAS platelets

Front 14

What type of transfusion reaction can be restarted?

Back 14

Urticarial

Front 15

Onset of Anaphylactic

Back 15

• During transfusion; after a few mls are transfused

Front 16

Which reactions occur after a few mLs of transfusion

Back 16

• Anaphylactic
• Bacterial Sepsis

Front 17

• SOB
  
• Bronchospasms
• Wheezing and coughing
• cyanosis
• hypotension
• angioedema
• nausea
• larynegeal/pharyngeal shock

Back 17

Anaphylactic

Front 18

Cause of Anaphylactic reaction

Back 18

• Most common: anti-IgA (IgE mediated)

• Antibody to donor plasma proteins

• Other: Ab to haptoglobin, penicillin, latex or C4

Front 19

Recommendations for future transfusion with an anaphylactic reactions

Back 19

• Avoid plasma transfusions
• All future products: IgA negative units
• 2-3L washed RBC/platelets

Front 20

• Fever with or without chills
• Nausea
• vomiting
• headache
• anxiety
• shaking (uncommon)

Back 20

Febrile Non-Hemolytic (FNH)

Front 21

Cause of FNH

Back 21

• Antibody to donor leukocytes; HLA
• Anti-platelets
• Accumulated cytokines in bag

Front 22

Recommendations for future transfusions in FNH reaction

Back 22

• Leuko-reduced blood; <5X10^6
• Premedicate with aspirin free antipyretic

Front 23

Onset of Bacterial sepsis

Back 23

• Acutre rapid onset within a few mLs of transfusion

Front 24

• High fever, chills
  
• Hypotension
• True rigors
• hemoglobinuria
• renal failure
• shock
• DIC

Back 24

Bacterial sepsis

Front 25

Causes of bacterial sepsis

Back 25

• Bacteria in blood

Front 26

TRALI

Back 26

Transfusion related lung injury

Front 27

• Respiratory distress/dypsnea
  
• Severe hypoxia (cyanosis)
• Fever
• Chills
• hypotension
• bilateral pulmonary edema

Back 27

TRALI

Front 28

Onset of TRALI

Back 28

within 1-2 hours up to 6 hours post transfusion

Front 29

Cause of TRALI

Back 29

• associated with components containing plasma
• Donor Ab to: Human Neutrophil antigen or anti-HLA Ab

Front 30

Recommendations for future transfusions in TRALI

Back 30

• Stop transfusion
  
• Start Oxygen therapy
• Plasma units from Donor: Male blood donor, never pregnant female, Females negative for HLA Ab

Front 31

DSTR

Back 31

delayed serological transfusion reaction

Front 32

6 tests for viral markers the must be performed on donor units (besides NAT)

Back 32

• Anti-HTLV I and II
  
• Anti-HCV
• Anti-HBC
• Anti-HIV 1&2
• Serologic test for syphilis

Front 33

Follow up tests after a transfusion reaction

Back 33

• Send out units: GS and culture
• Urine Hgb
• Repeat: ABO/Rh, Ab screen, complete crossmatch
• Monitor H&H, haptoglobin

Front 34

Unintended, undesirable occurence before, during, or after transfusion

Back 34

Adverse event

Front 35

Undesirable response or effect in a patient with blood components

Back 35

Adverse reactions

Front 36

any error or accident that could effect the quality or efficacy of blood components or transfusions

Back 36

Incident

Front 37

Immunologic transfusion reaction

Back 37

• IHTR
• Anaphylatic
• FNH
• Allegric/Utricarial
• DHTR
• TRALI

Front 38

Non-immunologic Transfusion reaction

Back 38

• TACO

• Bacterial contamination

• Hypothermia

• Hemolysis with out fever or symptoms

Front 39

Transfusion reactions with fever

Back 39

• IHTR
• DHTR
• FNH
• Bacterial sepsis
• TRALI

Front 40

Cause of DSTR

Back 40

• Rapid development of antibodies w/o lab evidence of hemolysis
  
• No signs/symptoms
• Not 1st exposure to an antigen

Front 41

TACO

Back 41

Transfusion circulatory overload

Front 42

Onset of TACO

Back 42

soon after transfusion

Front 43

Cause of TACO

Back 43

volume overload

Front 44

• Hypotension
• Headache
• CHF
• dyspnea
• cyanosis
• productive cough w/ pink forthy sputum
• renal failure

Back 44

TACO

Front 45

Treat TACO

Back 45

sit patient upright, admin O2, IV diuretics

Front 46

Iatrogenic:

Back 46

• mechanical in nature/overheating
  
• osmotic damage
• using needle with too small a bore to transfuse

Front 47

Considerations for future transfusion in iatrogenic (hemolysis w/o fever or symptoms)

Back 47

Transfuse RBC only with normal saline

QC blood warmers