Blood Component therapy II

Question 1

What is the pathophysiology of transfusion related acute lung injury? (2 hits)

Answer 1

PMN sequestration and priming–where they respond to a weak stimulus in the lungs

PMN activation and ROS generation

Question 2

What are the antibodies that are involved in TRALI?

Answer 2

Anti-HNA

Anti- HLA

Question 3

What is the presentation of TRALI?

Answer 3

Less than 6 hours after transfusion

Dyspnea/hypotension

Question 4

What are the official diagnostic criteria for TRALI? (4)

Answer 4

No evidence of acute lung injury prior to transfusion

Onset within 6 hours of transfusion cessation

Hypoxemia

Bilateral infiltrates

Question 5

What is the leading cause of transfusion related mortality in the US?

Answer 5

TRALI

Question 6

What is the treatment for TRALI?

Answer 6

O2 supplementation

Pressors

Question 7

SHould you give diuretics for TRALI? TACO?

Answer 7

Yes for taco, no for TRALI

Question 8

How do you prevent TRALI?

Answer 8

only allow donors who are at minimal risk for HLA/HNA antibodies

Question 9

Who are the donors who are at low risk of giving blood that can cause TRALI?

Answer 9

Males

nulliparous females

Question 10

Which has hypotension, and which has elevated BP: TACO vs TRALI

Answer 10

TACO = increased
TRALI = lower

Question 11

Who is most at risk of developing TACO?

Answer 11

Pts already at risk for volume overload

Question 12

What is the pathophysiology of acute hemolytic TR?

Answer 12

Antibodies in the pt against antigens on the transfused RBCs, leading to intravascular destruction

Question 13

Is acute hemolytic TR intravascular, or extravascular?

Answer 13

Intravascular

Question 14

How does acute hemolytic TR present? (3)

Answer 14

Hypotension
CVA TTP (kidney dmg)
red/dark urine

Question 15

How do you treat acute hemolytic TR?

Answer 15

Stop transfusion
IVF
Treat hypotension

Question 16

How do you prevent hemolytic TR?

Answer 16

Prevent clerical errors

Question 17

What is the pathophysiology of delayed hemolytic TR?

Answer 17

Pt has a lower titer of ab and recent transfusion is causing an increase

Question 18

What is the classic antibody that is seen in delayed hemolytic TR?

Answer 18

anti-Kidd

Question 19

Is delayed hemolytic TR extravascular or intravascular?

Answer 19

Extravascular

Question 20

How long does it take for delayed hemolytic TR to present?

Answer 20

days-weeks

Question 21

Extravascular hemolysis presents how?

Answer 21

Jaundice, leukocytosis

Question 22

What is the treatment for delayed hemolytic TR?

Answer 22

Supportive

Correct anemia

Question 23

What is the pathophysiology of posttransfusion purpura?

Answer 23

pt has anti-platelet antibodies d/t previous exposure to foreign platelets (prego)

Question 24

How long does it take for posttransfusion purpura to present?

Answer 24

9 days ish

Question 25

What are the symptoms of posttransfusion purpura/

Answer 25

thrombocytopenia Purpura Bleeding

Question 26

Mortality associated with posttransfusion purpura is usually caused by what?

Answer 26

Intracranial hemorrhage

Question 27

What is the treatment for posttransfusion purpura?

Answer 27

IVIG

Question 28

What is the pathophysiology of transfusion associated GVHD?

Answer 28

Blood component donor has a different HLA-type from the recipient T cells in the component attack host's HLA cells

Question 29

Who is at risk of developing TA-GHD?

Answer 29

immunocompromised

Question 30

How does TA-GVHD present? (3) How long?

Answer 30

3-30 days post transfusion Enterocolitis elevated LFTs Maculopapular rash

Question 31

What percent of TA-GVHD are fatal?

Answer 31

90%

Question 32

The risk of developing TA-GVHD is higher or lower with a very diverse population?

Answer 32

Lower

Question 33

How do you treat TA-GVHD?

Answer 33

Nothing successful

Question 34

How do you prevent TA-GVHD? What is the issue with this?

Answer 34

Irradiate RBCs--decreases shelf life of blood

Question 35

How long does it take for TTBI to present?

Answer 35

immediate to 5 hours

Question 36

TTBI is usually associated with giving what blood component? Why?

Answer 36

Platelets | Since they are stored at room temp

Question 37

What is the presentation of TTBI?

Answer 37

Fever

Question 38

Which type of bacteria cause a more severe rxn: gram positive or negative?

Answer 38

Negative (LPS)

Question 39

To be considered 100% diagnostic for TTBI, what must you do?

Answer 39

Identify same bacteria in blood cultures as the transfused blood component

Question 40

Why is it that you have to throw out the first few milliliters of blood taken?

Answer 40

Get rid of skin plug

Question 41

How do you prevent TTBI?

Answer 41

Culture platelets for 24 hours, and ensure negative

Question 42

What are the TRs that present with a fever?

Answer 42

``` Febrile TRALI Acute hemolytic TA-GVHD TTBI ```

Question 43

What is erythroblastosis fetalis?

Answer 43

Hemolytic disease of the newborn

Question 44

What is RHOgam?

Answer 44

anti D antibody, that will bind to fetal RBCs, and in maternal blood, and prevents immune response from mom

Question 45

Can you give RHOgam in moms who've already had HDNB

Answer 45

No

Question 46

In what clinical situations is RHOgam given?

Answer 46

threatened abortion Ectopic Fetal death in the 2nd or 3rd trimester