Transfusion Reactions

Question 1

Alloantibodies

Answer 1

Cold antibodies, usually not clinically significant

Question 2

Check cells

Answer 2

Control cells coated in IgG

Question 3

Bump in Platelet count after Transfusion

Answer 3

5000 ul/unit after transfusion

Question 4

Hemolytic Transfusion Rxn

Answer 4

Destroys transfused RBCs in-vivo and causes systemic damage

Question 5

Intravascular Hemolytic Transfusion Rxn

Answer 5

Usually acute, IgM activates complement which lyses the cells and increases serum and urine hemoglobin content

Question 6

Extravascular Hemolytic Transfusion Rxn

Answer 6

Ab coated RBCs are removed by liver and spleen, lysing the cells and releasing bilirubin, the Ab do not activate complement

Question 7

Nonhemolytic Transfusion Rxn Types

Answer 7

Febrile or allergic, caused by HLA antibodies

Question 8

Immediate/Acute Transfusion Rxn (Symptoms, Lab Findings)

Answer 8

Within hours of transfusion, fever, chills, flushing, tachycardia, hemoglobinemia, hemoglobinuria, hypotension → lead to DIC, renal failure, shock, and death. Will show increased bilirubin, low haptoglobin, and (+) DAT

Question 9

Delayed Transfusion Rxn (Lab Findings, specific Ab, symptoms, Secondary cause)

Answer 9

Days or weeks after transfusion, usually less severe (excluding Kidd) depending on the level of Ab in the blood, show fever and/or jaundice, from alloantibodies to Rh, Duffy, and Kidd. Show (+) DAT, (+) post- Ab screen low HGB and HCT. Can be due to a rebound in titer of an antibody which had decreased below detectable limits, Kidd antibodies are prone to this.

Question 10

Immune-mediated Transfusion Rxn (Cause, symptoms, patient type, correction)

Answer 10

RBC/HLA antigens reacting with Ab, cause nausea, vomiting, headache, back pain and FEVER (white cell rxns are most common cause of fever in transfusions). Found in patients with multiple pregnancies or transfusions. Antipyretics should correct the fever and the patient can receive leuko-reduced blood.

Question 11

Nonimmune-mediated Transfusion Rxn

Answer 11

Disease transmission, circulatory overload, hypothermia, hyperkalemia, and hypocalcemia

Question 12

Rh HDFN Lab Findings

Answer 12

Positive DAT, increased serum bilirubin

Question 13

Rhogam

Answer 13

Given to mothers so they do not develop alloantibodies to fetus’ RBCs

Question 14

3 Classes of HDFN

Answer 14

Caused by 1. Anti-D 2. antibodies against antigens in other systems (ie. anti-c and anti-K). 3. anti-A or anti-B in a group O woman

Question 15

ABO HDN (Cause, Treatment)

Answer 15

A or B babies born to an O mother, treated with phototherapy to break down excess bilirubin

Question 16

Predicting HDN

Answer 16

ABO/D on mother prior to delivery, along with Ab screen

Question 17

Confirming Suspected HDN

Answer 17

Testing of cord blood in those born to D(-) mothers, for ABO, D, and DAT

Question 18

Cross-match

Answer 18

Determine compatibility of donor blood to patient’s blood

Question 19

Compatibility

Answer 19

1. Review of patient’s past blood bank history and records 2. ABO and Rh grouping of the recipient and donor

2. Antibody screening of the recipient’s plasma

3. The crossmatch.
   Ab ID, ABO-Rh confirmation of donor cells, screening for antigens to known patient antibodies, and the transfusion; requires comparison of current work-up with any other work-ups from the same patient within the last 12 months; ABO and Rh (-) is repeated on all units from BB

Question 20

Maximum Surgical Blood Order Schedule (MSBOS)

Answer 20

Preformed according to the surgery the patient is having, choosing type and screen, cross-matching for two units, four units, or six units. Represents a a maximum, not minimum order.

Question 21

Gels

Answer 21

Uses dextran acrylamide gel with reagent or diluent. Anti-IgG cards are used for DATs and IATs

Question 22

When are Antibody Screens done?

Answer 22

Detects antibodies to specific antigens, used for pregnant women, pre-transfusion, donors, and in transfusion reactions

Question 23

IgM

Answer 23

Directly bind RBCs and activate complement, react at RT and below, usually clinically insignificant
Include Anti-A and Anti-B

Question 24

IgG

Answer 24

Cannot agglutinate RBCs, cannot activate complement without two molecules being present, react at 37C, cause transfusion reactions and HDN