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CCHS SBB > Adverse Effects of Transfusion > Flashcards

Adverse Effects of Transfusion Flashcards

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1
Q

hemovigilance according to AABB

A

collection of information on complications of transfusion, analysis of data, and subsequent data-driven improvement in transfusion practice

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2
Q

main purpose of hemovigilance

A

improve reporting of transfusion related adverse events

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3
Q

when are transfusion related fatalities reported to FDA?

A

ASAP with full written report within 7 days of the event

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4
Q

transfusion reaction signs and symptoms

A

fever 1C, chills, respiratory distress, hyper or hypotension, abdominal/check/flank/back pain, pain at infusion site, skin manifestations, jaundice or hemoglobinuria, nausea or vomiting, abnormal bleeding, oliguria or anuria

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5
Q

2 major groups of transfusion reactions

A

immediate (acute)

delayed

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6
Q

immediate hemolytic (immunologic) reactions

A

intravascular hemolytic

extravascular hemolytic

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7
Q

immediate non-hemolytic (immunologic)

A 
febrile
allergic
anaphylactic
TRALI
posttransfusion purpura
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8
Q

immediate non-immunologic reactions

A

bacterial
circulatory overload
hypothermic

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9
Q

usual cause of acute intravascular hemolytic reaction

A

ABO incompatibility, most often due to clerical error with mislabeling recipient’s pretransfusion sample at collection or failing to match intended recipient with blood product immediately before transfusion

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10
Q

acute intravascular hemolytic reaction clinical symptoms

A 
hypotension
fever
discomfort or anxiety
dyspnea
chills
facial flushing
kidney pain
bleeding from incision sites and mucous membranes
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11
Q

treatment for acute intravascular hemolytic reaction

A

stop transfusion, keep IV line open, give renal and cardiovascular supportive therapy

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12
Q

lab confirmation of acute intravascular hemolytic reaction

A 
positive DAT
Hgb in urine
elevated LDH
elevated bilirubin
decreased haptoglobin
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13
Q

how much ABO incompatible blood is required for acute intravascular hemolytic reaction?

A

as little as 10cc

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14
Q

what causes hemolysis in acute intravascular hemolytic reaction

A

ABO antibodies of patient destroy donor red cells in circulation; antibody binds complement which hemolyzes red cells directly in bloodstream

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15
Q

what is the key even leading to renal failure/hypotension/shock in acute intravascular hemolytic reaction?

A

Ag-Ab complexes cause release of vasoactive compounds (bradykinin) that cause vasodilation –> intravascular volume increases, blood pressure bottoms out and decrease in renal diffusion. Body responds with reflexive vasoconstriction to maintain blood pressure. Kidneys starved for blood

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16
Q

what causes acute extravascular hemolytic reaction?

A

pre-formed IgG antibody in patient
antibody missed or not detected during pre-transfusion testing or antibody identified by antigen positive red cells given

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17
Q

clinical symptoms of acute extravascular hemolytic reaction

A

fever

chills

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18
Q

clinical treatment of acute extravascular hemolytic reaction

A

stop transfusion, keep IV line open, give renal and cardiovascular supportive therapy

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19
Q

lab confirmation of acute extravascular hemolytic reaction

A

positive DAT
elution of antibody
decreased haptoglobin

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20
Q

what causes extravascular hemolysis

A

IgG antibody (other than ABO) of patient attaches to corresponding antigen on donor red cells; coated red cells are removed from circulation by liver and spleen and are destroyed extravascularly

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21
Q

what does posttransfusion sample look like in extravascular hemolytic reaction?

A

icteric due to increase in bilirubin

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22
Q

what does posttransfusion sample look like in intravascular hemolytic reaction?

A

hemolyzed due to hemoglobin release in bloodstream

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23
Q

transfusion reaction due to HLA antibodies in recipient’s serum to HLA antigens on white cells and/or platelets of donor

A

febrile immediate non-hemolytic

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24
Q

clinical symptoms of febrile immediate non-hemolytic reaction

A 
fever
may have mild chills
headache
nausea
nonproductive cough
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25
clinical treatment for febrile reaction
stop transfusion; treatment not required as symptoms go away quickly
26
lab confirmation of febrile reaction
negative DAT | negative gram stain/culture
27
prevention of febrile reactions
leukoreduction
28
onset of febrile reaction
during transfusion or up to 24 hours post transfusion
29
onset of allergic reaction
during transfusion or up to 24 hours post transfusion
30
clinical signs of allergic reaction
urticaria with itching occasional facial swelling wheezing no fever
31
treatment of allergic reaction
stop transfusion; give antihistamines and epinephrine
32
prevention of allergic reactions
pre-treat with antihistamines | may require washed products
33
incidence of allergic reactions
1-3%
34
incidence of febrile reactions
0.1-1% with leukocyte reduction
35
reaction due to IgA in donor plasma transfused to IgA deficient recipients with anti-IgA, cytokines
anaphylactic
36
clinical signs of anaphylactic reaction
``` flushing shock dyspnea hypotension NO fever ```
37
treatment of anaphylactic reaction
stop transfusion treat symptoms give epinephrine
38
prevention of anaphylactic reactions
washed RBCs or frozen/deglyced RBCs washed platelets products from IgA deficient donors
39
incidence of anaphylactic reactions
1:20,000-1:50,000
40
reaction due to white cell (HLA) antibodies in donor plasma reacting with recipient's granulocytes within 6 hours of tranfusion
TRALI
41
clinical signs of TRALI
``` pulmonary edema hypoxemia fever chills flushing dyspnea hypotension ```
42
treatment of TRALI
stop transfusion | immediately administer respiratory support
43
incidence of TRALI
1:5000-1:190,000
44
reaction due to platelet antibodies, usually associated with HPA-1a antigen
posttransfusion purpura
45
reaction due to bacterial contamination of blood products
transfusion-associated sepsis
46
product with highest risk of bacterial contamination
pooled products
47
clinical signs of transfusion-associated sepsis
``` fever chills increased pulse hypotension shock ```
48
treatment of transfusion-associated sepsis
stop transfusion | give IV antibiotics, treat symptoms
49
bacteria associated with unclean FFP thawing waterbath
Pseudomonas
50
bacteria associated with red cell products
Yersinia, Serratia
51
bacteria associated with platelet products
Staph, Enterobacter
52
inability of patient's circulatory system to handle increased fluid volume of transfusion
TACO
53
clinical symptoms of TACO
``` dyspnea cough neck vein distension pulmonary congestion edema ```
54
clinical treatment of TACO
stop transfusion | keep head of bed elevated, nasal oxygen, diuretics
55
resolution of TACO
smaller volume transfusions
56
incidence of TACO
<1%
57
reaction that can occur after receiving large amounts of cold blood that results in cardiac arrhythmia and cardiac arrest
hypothermic
58
types of delayed reactions
``` delayed hemolytic GVHD citrate toxicity transfusion hemosiderosis transmission of disease ```
59
reaction due to reactivated production of antibody in response to foreign RBC antigens
delayed hemolytic
60
what kind of hemolysis associated with delayed hemolytic reactions?
extraascular
61
clinical signs of delayed hemolytic reaction
mild jaundice fever drop in Hct
62
antibody associated with delayed hemolytic reactions
Kidd
63
incidence of delayed hemolytic reactions
1:2,500-1:11,000
64
occurs when immunocompetent donor lymphocytes engraft and multiply in recipient
GVHD
65
clinical symptoms of GVHD
skin rash, fever, diarrhea, liver failure, bone marrow suppression, death
66
clinical treatment of GVHD
none
67
prevention of GVHD
irradiated cellular products
68
how to decrease citrate toxicity?
calcium administration
69
increased iron deposits due to long-continued transfusion
transfusion hemosiderosis
70
diseases associated with transfusion
``` hepatitis B hepatitis C HIV syphilis CMV malaria ```
71
incubation period of hep B
6-26 weeks
72
most common form of hepatitis occurring with transfusion today
hep C
73
what products carry increased risk of hep and HIV transmission?
pooled components and plasma derived fractions of lyophilized factor VIII and IX
74
what percent of blood donors are said to have CMV infectious leukocytes?
6-12%
75
most common cause of acute hemolytic transfusion reaction
clerical error resulting in wrong ABO type transfused
76
when is bilirubin most effectively tested after suspected reaction?
6 hour post
77
most transfusion associated deaths are caused by?
acute hemolysis, anaphylaxis, sepsis, or TRALI

CCHS SBB (40 decks)

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