3S [LEC]: Adverse Effect of Blood Transfusion

Question 1

Unintended and deleterious occurrence associated with blood component transfusion

Answer 1

Adverse effect of blood transfusion

Question 2

Identify whether immediate or delayed and immune or non-immune:

Hemolytic

Answer 2

Immediate, immune

Question 3

Identify whether immediate or delayed and immune or non-immune:

Febrile, nonhemolytic

Answer 3

Immediate, immune

Question 4

Identify whether immediate or delayed and immune or non-immune:

Allergic

Answer 4

Immediate, immune

Question 5

Identify whether immediate or delayed and immune or non-immune:

Anaphylactic

Answer 5

Immediate, immune

Question 6

Identify whether immediate or delayed and immune or non-immune:

TRALI

Answer 6

Immediate, immune

Question 7

Identify whether immediate or delayed and immune or non-immune:

Sepsis

Answer 7

Immediate, non-immune

Question 8

Identify whether immediate or delayed and immune or non-immune:

TACO

Answer 8

Immediate, non-immune

Question 9

Identify whether immediate or delayed and immune or non-immune:

Physical hemolysis

Answer 9

Immediate, non-immune

Question 10

Identify whether immediate or delayed and immune or non-immune:

Serologic: RBC

Answer 10

Delayed, immune

Question 11

Identify whether immediate or delayed and immune or non-immune:

HLA alloimmunization

Answer 11

Delayed, immune

Question 12

Identify whether immediate or delayed and immune or non-immune:

TA-GVHD

Answer 12

Delayed, immune

Question 13

Identify whether immediate or delayed and immune or non-immune:

Posttransfusion purpura

Answer 13

Delayed, immune

Question 14

Identify whether immediate or delayed and immune or non-immune:

Hemosiderosis

Answer 14

Delayed, non-immune

Question 15

Identify whether immediate or delayed and immune or non-immune:

Citrate toxicity

Answer 15

Delayed, non-immune

Question 16

Identify whether immediate or delayed and immune or non-immune:

Massive transfusion

Answer 16

Delayed, non-immune

Question 17

First step when adverse effect of blood transfusion occurs

Answer 17

Stop transfusion

Question 18

Second step when adverse effect of blood transfusion occurs

Answer 18

Investigate

Question 19

Collection of information on the complications of transfusion, analysis of these data, and subsequent data-driven improvements

Answer 19

Hemovigilance

Question 20

Identify the non-infectious transfusion reaction:

Development of non-ABO antibodies following RBC transfusion, pregnancy, or transplantation

i. Alloimmunization to RBC antigens
ii. Acute Hemolytic Transfusion Reaction (AHTR)
iii. Delayed Hemolytic and Serologic Transfusion Reaction (DHTR)
iv. Transfusion-Related Acute Lung Injury (TRALI)

Answer 20

i

Question 21

Identify the non-infectious transfusion reaction:

Combination of signs and symptoms associated with hemolysis, biochemical evidence of hemolysis and serologic evidence of RBC incompatibility occurring during or within 24 hours after transfusion

i. Alloimmunization to RBC antigens
ii. Acute Hemolytic Transfusion Reaction (AHTR)
iii. Delayed Hemolytic and Serologic Transfusion Reaction (DHTR)
iv. Transfusion-Related Acute Lung Injury (TRALI)

Answer 21

ii

Question 22

Identify the non-infectious transfusion reaction:

Accelerated destruction of transfused RBCs due to antibody-mediated incompatibility

i. Alloimmunization to RBC antigens
ii. Acute Hemolytic Transfusion Reaction (AHTR)
iii. Delayed Hemolytic and Serologic Transfusion Reaction (DHTR)
iv. Transfusion-Related Acute Lung Injury (TRALI)

Answer 22

ii

Question 23

Most common symptom of AHTR

Answer 23

Fever (often with chills and rigors)

Question 24

Identify the non-infectious transfusion reaction:

A positive DAT 24 hours to 28 days after transfusion with either a positive eluate or a newly identified alloantibody in the plasma or serum and evidence of hemolysis

i. Alloimmunization to RBC antigens
ii. Acute Hemolytic Transfusion Reaction (AHTR)
iii. Delayed Hemolytic and Serologic Transfusion Reaction (DHTR)
iv. Transfusion-Related Acute Lung Injury (TRALI)

Answer 24

iii

Question 25

Identify the non-infectious transfusion reaction: Delayed Hemolytic and Serologic Transfusion Reaction without evidence of hemolysis i. Alloimmunization to RBC antigens ii. Acute Hemolytic Transfusion Reaction (AHTR) iii. Transfusion-Related Acute Lung Injury (TRALI) iv. Delayed Serologic Transfusion Reaction (DSTR)

Answer 25

iv

Question 26

Delayed TRALI occurs within ___ after transfusion

Answer 26

6-72 hours

Question 27

Identify the non-infectious transfusion reaction: "White out" appearance of acute pulmonary edema i. Alloimmunization to RBC antigens ii. Acute Hemolytic Transfusion Reaction (AHTR) iii. Delayed Hemolytic and Serologic Transfusion Reaction (DHTR) iv. Transfusion-Related Acute Lung Injury (TRALI)

Answer 27

iv

Question 28

Identify the non-infectious transfusion reaction: Evidence of hypoxemia by blood gas or oxygen saturation testing i. Alloimmunization to RBC antigens ii. Acute Hemolytic Transfusion Reaction (AHTR) iii. Delayed Hemolytic and Serologic Transfusion Reaction (DHTR) iv. Transfusion-Related Acute Lung Injury (TRALI)

Answer 28

iv

Question 29

Identify the non-infectious transfusion reaction: Presence of three or more features of fluid overload occurring within 6 hours after transfusion i. Transfusion-Associated Circulatory Overload (TACO) ii. Transfusion-Associated Dyspnea (TAD) iii. Hypotensive Transfusion Reaction iv. Febrile Nonhemolytic Transfusion Reaction

Answer 29

i

Question 30

Identify the non-infectious transfusion reaction: 2nd most common cause of transfusion-related deaths i. Transfusion-Associated Circulatory Overload (TACO) ii. Transfusion-Associated Dyspnea (TAD) iii. Hypotensive Transfusion Reaction iv. Febrile Nonhemolytic Transfusion Reaction

Answer 30

i

Question 31

Identify the non-infectious transfusion reaction: Increased intravascular volume due to excessive transfused fluid and/or too rapid infusion rate i. Transfusion-Associated Circulatory Overload (TACO) ii. Transfusion-Associated Dyspnea (TAD) iii. Hypotensive Transfusion Reaction iv. Febrile Nonhemolytic Transfusion Reaction

Answer 31

i

Question 32

In TAD, dyspnea occurs within ___ hours after transfusion and all other diagnoses are excluded

Answer 32

24

Question 33

In TACO, the signs and symptoms are frequently seen within ___ hours after start of transfusion but may take up to ___ hours to be seen

Answer 33

2 hours 6 hours

Question 34

T/F: In TACO, there is no direct relationship between transfused volume and severity of clinical symptoms

Answer 34

True

Question 34

Identify the non-infectious transfusion reaction: Has an unknown pathophysiology i. Transfusion-Associated Circulatory Overload (TACO) ii. Transfusion-Associated Dyspnea (TAD) iii. Hypotensive Transfusion Reaction iv. Allergic Transfusion Reaction (ATR)

Answer 34

ii

Question 35

In hypotensive transfusion reaction, hypotension is seen alone during or within ___ hours after transfusion is finished

Answer 35

1 hour

Question 36

In hypotensive transfusion reaction, adults will experience a drop in the systolic of ___, which is equivalent to a systolic blood pressure of ___

Answer 36

>/= 30 mmHg

Question 37

In hypotensive transfusion reaction, children will experience how much drop in the baseline systolic blood pressure?

Answer 37

25%

Question 38

In FNHTR, what is the common body temperature of the patient?

Answer 38

100.4F (38C) or a change of at least 1.8F (1.0C)

Question 39

In FNHTR, the fever, chills, and rigor will be present within how many hours after transfusion?

Answer 39

4 hours

Question 40

T/F: FNHTR is not diagnosed without the presence of fever

Answer 40

False (chills/rigor without fever can still be diagnoses as FNHTR)

Question 41

Identify the non-infectious transfusion reaction: Most common reaction seen with platelet and plasma transfusions i. Transfusion-Associated Circulatory Overload (TACO) ii. Transfusion-Associated Dyspnea (TAD) iii. Hypotensive Transfusion Reaction iv. Allergic Transfusion Reaction (ATR)

Answer 41

iv

Question 42

ATR is a type ___ hypersensitivity

Answer 42

I

Question 43

ATR cases use ___ prior to transfusion

Answer 43

Antihistamines

Question 44

Identify the non-infectious transfusion reaction: A clinical syndrome that is characterized by the typical skin rash, diarrhea, fever, enlarged liver, elevated liver enzymes, marrow aplasia, pancytopenia i. Transfusion-Associated Circulatory Overload (TACO) ii. Transfusion-Associated Graft-Versus-Host Disease iii. Hypotensive Transfusion Reaction iv. Allergic Transfusion Reaction (ATR)

Answer 44

ii

Question 45

Identify the non-infectious transfusion reaction: Has a high mortality rate of 90% i. Transfusion-Associated Circulatory Overload (TACO) ii. Transfusion-Associated Graft-Versus-Host Disease iii. Hypotensive Transfusion Reaction iv. Allergic Transfusion Reaction (ATR)

Answer 45

ii

Question 46

In TA-GVHD, which specific immune cell is directed against the recipient cell surface histocompatibility antigens and mediate cell destruction?

Answer 46

CD8+ Cytotoxic T Cells

Question 47

Identify the non-infectious transfusion reaction: Prevented by irradiation of cellular blood components i. Transfusion-Associated Circulatory Overload (TACO) ii. Transfusion-Associated Graft-Versus-Host Disease iii. Hypotensive Transfusion Reaction iv. Allergic Transfusion Reaction (ATR)

Answer 47

ii

Question 48

Identify the non-infectious transfusion reaction: A severe and sudden drop in the PLT count due to alloimmunization to platelet-specific antibodies from prior transfusion or pregnancy i. Transfusion-Associated Circulatory Overload (TACO) ii. Post-transfusion Purpura iii. Refractoriness to PLT transfusion and alloimmunization iv. Adverse metabolic effects of transfusion

Answer 48

ii

Question 49

Post-transfusion purpura usually occurs within ___ days after transfusion

Answer 49

5-10 days

Question 50

Two most common effects of of adverse metabolic effects of transfusion

Answer 50

Citrate toxicity Hyperkalemia

Question 51

Most frequent infection-associated with transfusion

Answer 51

Transfusion-transmitted bacterial infections (TTBI)

Question 52

Species of bacteria that causes the greatest number of deaths due to blood product contamination

Answer 52

S. aureus

Question 53

Which non-infectious transfusion reactions should be considered when hypotension and respiratory symptoms are present?

Answer 53

TRALI and Anaphylactoid Reactions

Question 54

T/F: In RBC products, Gram negative bacteria are most prevalent

Answer 54

True

Question 55

T/F: In platelet products, Gram negative bacteria are most prevalent

Answer 55

False (Gram pos)

Question 56

Which bacteria is most prevalent in RBC blood products?

Answer 56

Enterobacteriaceae

Question 57

An automation system that uses photochemical treatment process using a psoralen derivative for treatment of plasma and platelets

Answer 57

INTERCEPT system

Question 58

What component is most frequently involved with transfusion-associated sepsis? i. Plasma ii. Packed RBCs iii. Platelets iv. Whole blood

Answer 58

i

Question 59

Fatal transfusion reactions are mostly caused by: i. Serologic errors ii. Improper storage of blood iii. Clerical errors iv. Improper handling of the product

Answer 59

iii

Question 60

Early manifestation of an acute hemolytic transfusion reaction can be confused with: i. Allergic reaction ii. Febrile nonhemolytic reaction iii. Anaphylactic shock iv. Sepsis

Answer 60

ii

Question 61

Pain at infusion site and hypotension are observed with what type of reaction? i. Delayed hemolytic transfusion reaction ii. Acute hemolytic transfusion reaction iii. Allergic reaction iv. Febrile nonhemolytic reaction

Answer 61

ii

Question 62

Irradiation of blood is performed to prevent: i. Febrile nonhemolytic transfusion reaction ii. Delayed hemolytic transfusion reaction iii. Transfusion-associated graft-versus-host disease iv. Transfusion-associated allergic reaction

Answer 62

iii

Question 63

A suspected transfusion-related death must be reported to: i. AABB ii. FDA iii. CAP iv. TJC

Answer 63

ii

Question 64

Nonimmune hemolysis can be caused during transfusion by: i. Use of small bore size needle ii. Use of an infusion pump iii. Improper use of a blood warmer iv. All of the above

Answer 64

iv

Question 65

Transfusion reactions are classified according to: i. Signs and symptoms during or after 24 hours ii. Immune or nonimmune iii. Infectious or noninfectious iv. All of the above

Answer 65

iv

Question 66

With febrile nonhemolytic transfusion reactions: i. They are self-limited ii. Fever resolves within 2-3 days iii. Treatment is required iv. i and ii are correct v. All of the above

Answer 66

v

Question 67

Absolute IgA deficiency is a classic example of a severe allergic reaction. A result indicating an absolute IgA deficiency is: i. <0.05 mg/dL ii. <0.50 mg/dL iii. <0.50 gm/dL iv. <5 mg/dL

Answer 67

i

Question 68

How are mild allergic transfusion reactions with isolated symptoms or hives and urticaria treated? i. Transfusion is stopped, reaction workup is initiated ii. Transfusion is stopped, antihistamines administered, transfusion is restarted when symptoms improve iii. Stop transfusion and prepare washed RBC iv. Continue transfusion with a slower infusion rate

Answer 68

ii

Question 69

TRALI presents with the following symptoms: i. Respiratory distress ii. Severe hypoxia and hypotension iii. Fever iv. All of the above

Answer 69

iv

Question 70

Which of the following is characteristic of iron overload? i. Delayed, nonimmune complication occurs ii. Chelating agents are used iii. Multiorgan damage may occur iv. All of the above

Answer 70

iv