Blood Component therapy II Flashcards Preview

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Flashcards in Blood Component therapy II Deck (46):
1

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

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

PMN activation and ROS generation

2

What are the antibodies that are involved in TRALI?

Anti-HNA
Anti- HLA

3

What is the presentation of TRALI?

Less than 6 hours after transfusion

Dyspnea/hypotension

4

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

No evidence of acute lung injury prior to transfusion

Onset within 6 hours of transfusion cessation

Hypoxemia

Bilateral infiltrates

5

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

TRALI

6

What is the treatment for TRALI?

O2 supplementation
Pressors

7

SHould you give diuretics for TRALI? TACO?

Yes for taco, no for TRALI

8

How do you prevent TRALI?

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

9

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

Males

nulliparous females

10

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

TACO = increased
TRALI = lower

11

Who is most at risk of developing TACO?

Pts already at risk for volume overload

12

What is the pathophysiology of acute hemolytic TR?

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

13

Is acute hemolytic TR intravascular, or extravascular?

Intravascular

14

How does acute hemolytic TR present? (3)

Hypotension
CVA TTP (kidney dmg)
red/dark urine

15

How do you treat acute hemolytic TR?

Stop transfusion
IVF
Treat hypotension

16

How do you prevent hemolytic TR?

Prevent clerical errors

17

What is the pathophysiology of delayed hemolytic TR?

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

18

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

anti-Kidd

19

Is delayed hemolytic TR extravascular or intravascular?

Extravascular

20

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

days-weeks

21

Extravascular hemolysis presents how?

Jaundice, leukocytosis

22

What is the treatment for delayed hemolytic TR?

Supportive
Correct anemia

23

What is the pathophysiology of posttransfusion purpura?

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

24

How long does it take for posttransfusion purpura to present?

9 days ish

25

What are the symptoms of posttransfusion purpura/

thrombocytopenia
Purpura
Bleeding

26

Mortality associated with posttransfusion purpura is usually caused by what?

Intracranial hemorrhage

27

What is the treatment for posttransfusion purpura?

IVIG

28

What is the pathophysiology of transfusion associated GVHD?

Blood component donor has a different HLA-type from the recipient

T cells in the component attack host's HLA cells

29

Who is at risk of developing TA-GHD?

immunocompromised

30

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

3-30 days post transfusion

Enterocolitis
elevated LFTs
Maculopapular rash

31

What percent of TA-GVHD are fatal?

90%

32

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

Lower

33

How do you treat TA-GVHD?

Nothing successful

34

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

Irradiate RBCs--decreases shelf life of blood

35

How long does it take for TTBI to present?

immediate to 5 hours

36

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

Platelets
Since they are stored at room temp

37

What is the presentation of TTBI?

Fever

38

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

Negative (LPS)

39

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

Identify same bacteria in blood cultures as the transfused blood component

40

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

Get rid of skin plug

41

How do you prevent TTBI?

Culture platelets for 24 hours, and ensure negative

42

What are the TRs that present with a fever?

Febrile
TRALI
Acute hemolytic
TA-GVHD
TTBI

43

What is erythroblastosis fetalis?

Hemolytic disease of the newborn

44

What is RHOgam?

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

45

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

No

46

In what clinical situations is RHOgam given?

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