Exam C Study Guide Flashcards
1
Q
Goals of Transfusion Therapy?
A
to increase tissue oxygenation and/or restore hemostasis.
2
Q
Four Major Categories of Blood Products?
A
-Cellular components
-Plasma components
-Hematopoietic progenitor cell (HPC)
-Plasma fractionation products
3
Q
What are the different cellular components?
A
-whole blood
-red cells
-granulocytes
4
Q
What are the different plasma components?
A
platelet products, cryoprecipitate, fresh frozen plasma, other transfusable plasma components
5
Q
What are the Hematopoietic progenitor cell (HPC) products?
A
bone marrow, peripheral blood stem cell and cord blood cell preparations
6
Q
What are the plasma fractionation products?
A
albumin, various immune globulins, coagulation factor concentrates
7
Q
Acid-citrate-dextrose:
-good for ____ days
-pH?
A
-21
-lowest pH of any blood preservatives
8
Q
What are the different Red Blood Cell preservatives?
A
-ACD
-CPD
-CPDA-1
-CP2D-AS
9
Q
Citrate-phosphate-dextrose (CPD):
-good for ____ days
-pH?
A
-21 days
-Decreases red blood cell pH; however, not as much as ACD
10
Q
Citrate-phosphate-dextrose-adenine (c. CPDA-1):
-good for _____days
A
35
11
Q
What does Citrate-phosphate-dextrose-adenine (CPDA-1) do?
A
-Adenine increases ADP levels therefore causing ATP formation
-Decreased 2,3 DPG by day 35
12
Q
Citrate-phosphate-dextrose (CP2D-AS):
-good for _____ days
A
42
13
Q
What is the advantage of Citrate-phosphate-dextrose (CP2D-AS)?
A
2,3 DPG and ATP values are improved over CPDA-1; however, by the 42nd day the 2,3 DPG and ATP levels are significantly decreased
14
Q
What are the additive solutions used for RBC preservation?
A
AS-1, AS-3, AS-5
15
Q
What dos AS-1, AS-3,
and AS-5 all have?
A
All have saline, adenine and glucose
16
Q
Additive solutions:
___ and ____ have mannitol to protect against storage lesions.
A
AS-1, AS-5
17
Q
Additive solutions:
____ has citrate and phosphate to protect from storage lesions.
A
AS-3
18
Q
AS-____ is approved in Europe, but not in the US
A
7
19
Q
The infusion of all blood components should occur in less than ____ hours.
A
4
-The infusion rate may be adjusted to allow for individual patient circumstances but should fall within the 4-hour limit.
20
Q
What should be documented as part of the order to transfuse?
A
infusion rate
21
Q
The 4-hour limit does not necessarily apply to infusion of __________ products
A
fractionation
22
Q
The basic infusion set incorporates flexible plastic tubing and a standard inline blood filter with a pore size of ______ microns.
A
170–260
23
Q
_____________ filters may be used for red blood cell transfusions.
A
Microaggregate
24
Q
Leukocyte reduction filters are used to reduce the number of white blood cells in red blood cell or platelet components to less than _____ white blood cells per unit.
A
5 × 10^6
25
Are filters used for red blood cell components interchangeable with the filters designed for platelet components?
No
-Using a needle with too small a bore diameter may cause hemolysis when transfusing red blood cells. As with other transfusion parameters, needle size may vary with patient conditions
26
Why should the infusion rate be slowed when using smaller needles when transfusing RBCs?
to prevent hemolysis
-Needles with a large-bore diameter should be used when rapidly transfusing red blood cells.
27
-Rapid infusers resemble pressure cuffs that surround the entire bag of blood.
-Rapid infusers should not be inflated to _____mm Hg or above because this level of pressure may cause the bag to rupture.
300
28
Massive rapid infusion or infusion into a central venous catheter carries a higher risk of __________.
hypothermia
Blood warmers can be used to prevent hypothermia but should be maintained and monitored so the blood never reaches a temperature that could cause hemolysis.
29
__________ pumps can be used to regulate the blood flow into the patient.
-These are often used in neonates where small shifts in volume may drastically affect the infant
Mechanical
30
When would mechanical pumps be used in adults?
when rate control is indicated.
31
True or false:
Normal saline, 0.9% sodium chloride (USP), may be added to most blood components.
True
32
Generally, medications and other intravenous solutions should not be added to blood components as they may cause...
clotting or hemolysis.
33
Some examples of substances that have regulatory approval to safely add to red blood cell units include...
ABO-compatible plasma, 5% albumin, and Plasma-Lyte®.
34
Ringer’s lactate solution should not be added to blood components because the high _______ content inactivates the anticoagulant, causing clots to form.
calcium
35
What are the uses of whole blood?
-Exchange transfusions
-Acute massive blood loss
36
True or false:
Fresh whole blood may be used in specific circumstances but for the most part it has been replaced by specific component therapy
True
37
If whole blood is used, it should be ____ identical and should be crossmatched.
ABO
38
Each unit of whole blood should increase the patient’s hematocrit by ___% and hemoglobin by ___%
3, 1
39
Storage time for Whole blood:
-CPD up to ___ days
-CPDA-1 up to ___ days
-CPD-AS up to ____ days
21
35
42-45
40
What are some of the uses of Packed Red Blood Cells?
-Anemia
-Most blood replacements during surgery
-Pre-operative transfusions
-In severe, acute blood loss it, along with other components and fluids can correct the situation
41
What is the storage time for PRBCs compared to whole blood
the same
42
Patients with a hemoglobin concentrate above ___/dL (100 g/L) rarely need a blood transfusion.
10
43
Patients with a hemoglobin below ___ g/dL (70 g/L)... many patients experience symptoms of poor oxygenation and benefit from red blood cell transfusions.
7
44
Between ____ and ___ g/dL (70 and 100 g/L), the patient’s clinical presentation and the particular problem being treated exert more influence on the decision to transfuse.
7, 10
45
Stored whole blood may be used in preoperative autologous donation (PAD) programs, when a patient donates one or more units of blood _____ weeks before a scheduled surgery.
1-3
In PAD, collected units are often held as whole blood to eliminate the costs involved in component preparation and storage.
46
Directed Donation:
If the donation is from a first-degree family member, this unit must be _______ prior to infusion in order to prevent transfusion-associated graft versus host disease (TA-GVHD).
irradiated
-Units are screened for infectious diseases in the same manner as community donors.
47
Directed Donations:
What is done with plasma portions of the units?
Directed units are processed into packed red blood cell units. Plasma portions of these units are usually placed in the main donor supply and not designated for the recipient of the directed donation.
48
Ture or false:
If the red blood cell unit is not transfused to the intended recipient it may cross over into the main donor supply.
True
49
Granulocyte Transfusion is used primarily to treat?
neutropenic patients who have bacterial and/or fungal sepsis that has been shown to be resistant to antimicrobial interim therapy. Thus, granulocyte therapy is not generally a first-line therapy for these patients.
50
Granulocyte Transfusion is given as interim therapy for what patients?
for patients who are expected to recover neutrophil production, as well as those with congenital abnormalities in neutrophil function
51
Granulocytes are prepared from either apheresis technique or from fresh whole blood. They are stored at room temperature and expire _________ after preparation
24 hours
52
Granulocyte units should be transfused as soon as possible, and must be transfused within ___ hours of collection, to obtain the most viable cell dose.
24
53
Granulocyte units should always be irradiated to prevent ______ but should not be infused with microaggregate or leukoreduction filters.
TA-GVHD
54
The donor and recipient should be both ___ and ______________ (HLA) compatible.
Rh and human leukocyte antigen
55
A crossmatch should be performed if more than ___ mL of red blood cells are present in the granulocyte unit.
2
56
Leukocyte reduction filters are available that can be used with...
whole blood, red blood cell or platelet units.
57
Purpose of leukoreduction?
Helps to prevent the formation of antibodies to HLA antigens because white blood cells carry HLA antigens.
58
Leukoreduction can be done by...
centrifugation, filtering upon unit preparation, washing the product or filtering at bedside.
59
Who should receive leukoreduced cellular blood products?
Patients who would be most adversely affected by alloimmunization to HLA antigens (duh)
-Other patients that benefit from leukoreduction are patients with febrile, nonhemolytic transfusion reactions.
60
Leukoreduction decreases the viral load in the product and therefore can reduce the incidence of transfusion-related transmission of viruses known to reside on white blood cells (such as...
human T-cell lymphotropic virus [HTLV-1] and Epstein-Barr virus [EBV])
61
Leukoreduction can also prevent ________ to platelet transfusions
rectroriness
-Please note that single-donor platelets can be collected by an apheresis machine in a manner that renders the product leukodepleted during the collection process
62
What is irradiation used for?
To prevent TA-GVHD (transfusion-associated graft-versus-host disease).
63
TA-GVHD occurs when viable transfused lymphocytes...
replicate in the recipient, recognize them as foreign, and mount a destructive immune response against the recipient’s body.
64
What is the risk of TA-GVHD (transfusion-associated graft-versus-host disease)?
a pancytopenia within days of the transfusion and is almost uniformly fatal.
65
This disrupts the DNA in the white blood cell nuclei, which destroys the white blood cell’s ability to replicate.
Gamma irradiation
66
To prevent TA-GVHD the blood component should receive a radiation dose of _____ Gy (2500 cGY) delivered to the midplane and ___ Gy (1500 cGy) to all parts of the bag.
25, 15
67
Since immunocompromised patients are most susceptible to TA-GVHD, they commonly receive _________ red blood cell and platelet units.
irradiated
68
Products that are from a first-degree relative of the recipient must be __________, as the recipient would be at a high risk for TA-GVHD
irradiated
69
CMV infection is often asymptomatic in a person with a robust immune system.
In immune suppressed individuals, CMV infection can cause...
debilitating effects and even death.
70
Patient populations where transfusion-transmitted CMV infection can cause significant morbidity and mortality include:
-Low birth weight infants (<1500g)
-CMV seronegative HPC transplant recipients or potential recipients
-CMV seronegative antepartum women
-Fetuses receiving intrauterine transfusion
-HIV-infected patients and children born to HIV-positive mothers
71
What are the two methods to decrease the risk of transfusion-associated CMV transmission?
-Leukoreduction
-Testing blood donors for antibodies to CMV
72
How does leukoreduction prevent CMV?
CMV infects white blood cells; therefore, leukoreduction can reduce the viral load in blood components
73
In order to reduce CMV transmission and HLA alloimmunization, some countries have converted their blood supply to __________.
prestorage
74
What is the incidence of CMV infection in the general population?
varies and can be quite high.
75
Will leukoreduction or CMV seronegativity confer complete protection from CMV?
-neither confer complete protection from transition.
-The combo of both offers the most protection
76
Washing of red blood cell and platelet units is indicated in only a few clinical situations.
The procedure uses centrifugation most often in an _____ system.
open
77
Washed red blood cell units expire in _____ hours from the time of washing, platelets in ___ hours.
24, 4
78
***Washing of red blood cell units eliminates approximately ____% of the white blood cells, about ____% of red blood cell mass, and virtually ____% of the plasma.
85, 15, 99
79
True or false:
Washed red blood cell and platelet components can be transfused to IgA-deficient patients who have antibodies to IgA.
True
80
_________ may be indicated in patients who have severe allergic reactions to blood products.
Washing
81
Washing should not be used as a means to reduce __________.
white blood cells
82
Blood from donors with rare red blood cell phenotypes may be stored frozen for up to ____ years and used for autologous or allogeneic transfusion.
10
83
Freezing:
Each unit is phenotyped extensively prior to freezing using a cryoprotective agent, such as 20 or 40% glycerol. When the unit is to be transfused the cryoprotective agent must be washed; this process is called _____________.
deglycerolization
84
The deglycing procedure is as follows:
a. ____% sodium chloride solution
b. _____% sodium chloride solution with 0.2 gm% glucose solution
12%, 0.9%
85
The expiration date of the deglycerolized red blood cell components is ______hours for open systems or ____weeks for closed systems
24, 2
86
True or false:
Cryopreservation of platelets is widely available.
False. Not widely available.
87
_______ is the most common cryopreservative used for frozen platelet storage.
DMSO
88
Frozen platelet products can be stored for ___ years.
2
89
What are three types of plasma-derived products commonly used?
Fresh frozen plasma (FFP), platelet products, and cryoprecipitate
90
FFP normally comes from whole blood donations.
-It must be removed and frozen within ____ hours.
8
91
Fresh Frozen Plasma is primarily used to...
to replace dysfunctional or deficient coagulation proteins. Coagulation factor deficiencies are usually caused by congenital diseases.
92
Fresh Frozen Plasma uses:
Multiple coagulation deficiencies are often present in patients with _______ damage or failure.
liver
-Vitamin K antagonists or deficiencies affect multiple coagulation factors
93
What is the storage for FFP when frozen?
-18oC or colder for 1 year
94
What is the storage for FFP when thawed?
1-6oC for 4 hours or 5 days, but 5 day storage loses some of the important coagulation factors.
95
1 unit of FFP should increase the coagulation factors by about _____%.
25-30
96
FFP should not be used to dilute red blood cell units for faster infusion. ____________ can be used and will not expose the patient to another donor.
Crystalloids
97
Specific coagulation factor concentrates have largely replaced FFP as the treatment of choice for people with congenital factor abnormalities. FFP is usually only used if...
no factor concentrate is available.The decision to treat patients with FFP should not be based solely on laboratory values but should take into consideration the patient’s underlying disease and clinical status.
98
Platelet components are prepared from a single donor or random donor. The single donor is typically an apheresis procedure in which one bag is equivelant to ____ random donor platelets. The random donor platelet is obtained from a whole blood donation.
6-8
99
Platelets are viable for up to ___ days, but must be stored at room temp and continuously shaken and if the system is opened, they will expire in ___ hours upon opening.
5, 4
100
Platelet uses?
-Indicated in a variety of clinical situations where decreased platelet production, increased platelet destruction, or platelet dysfunction may lead to bleeding.
-Certain thrombocytopenic patients may benefit from prophylactic platelet transfusion to reduce bleeding risk.
101
A platelet count of less than _______________ is often used as a trigger to initiate prophylactic platelet transfusions to prevent intracranial hemorrhage.
10 × 10^3/µL (10 × 109/L)
102
Common patient groups with low platelet counts that are treated prophlactically include:
-Premature neonates
-Cancer patients receiving chemotherapy and transplant patients
-Transplant patients of both solid organ and HPC.
103
1 unit of platelets should increase the platelet count by...
5,000-10,000
104
Many donor centers primarily collect apheresis platelet products, which are also called single-donor platelets. For adults, the usual dose per transfusion is ___ apheresis platelet or ____ whole blood–derived platelets. Typical dosage of whole blood–derived platelets can vary among facilities from 4 to 10 units per dose. Apheresis platelets where the donor and recipient are matched for certain antigens may be transfused when a recipient becomes refractory to platelet transfusions.
1, 6
105
Cryoprecipitate is manufactured from what blood component?
FFP
106
The major use of cryoprecipitate is as a source of ___________.
fibrinogen
-but can also be used to treat congenital deficiencies or dysfunctions of fibrinogen.
106
What does Cryoprecipitate contain?
contains factor VIII, fibrinogen, von Willebrand factor (vWF), Factor XIII, and fibronectin.
106
What is storage for cryoprecipitate?
-18oC for one year from draw date
- room temperature for 4 hours after thawing
107
Cryoprecipitate:
One bag should increase Factor VIII by ____ units and Factor 1 by ____mg/dL
80
5
108
What may eventually replace the use of cryoprecipitate as fibrinogen replacement?
Human fibrinogen (RiastapTM) was approved by the U.S. Food and Drug Administration (FDA) in 2009 to treat patients with a congenital fibrinogen deficiency. A recombinant human fibrinogen product is available in Europe and may eventually replace the use of cryoprecipitate
109
Plasma Fractionation Products: The FDA and the __________ Association provide oversight and accreditation of plasma fractionation facilities in the United States.
Plasma Protein Therapeutics
110
Who distributes plasma fractionation products?
by the transfusion service or by the pharmacy
111
What are Coagulation Factor Concentrates used for?
to prevent or to treat bleeding episodes in patients with coagulation deficiencies
-targeted therapy with the appropriate factor concentrate.
112
What are the benefits of Factor concentrates over broad-spectrum treatment with FFP transfusion?
are easier to transfuse and safer for the patient
113
Factor concentrates have a smaller volume and have less risk of disease transmission because of what step?
viral inactivation steps used in the manufacturing process.
114
Several factor concentrates are now made in a recombinant form and contain no human plasma-derived products, reducing the risk of infectious disease transmission theoretically to _____.
zero
115
What are the most commonly used factor concentrates?
-Factor VIII
-Factor IX
-Factor VIIa
116
Other plasma-derived protein concentrates include...
antithrombin, protein C, and C1-esterase inhibitor.
117
Factor VIII is for the treatment of...
Hemophilia A, von Willebrand’s disease
118
Factor IX is for the treatment of...
Hemophilia B
119
Factor VIIa is for the treatment of...
either hereditary or acquired Factor VII deficiency.
120
The protein that is present in the largest amount in human plasma.
Albumin
121
-Contributes to fluid balance both within the blood vessels and throughout the body.
-Most commonly used as a volume replacement in trauma, shock, burns, and therapeutic plasma exchange.
Albumin
122
Common indications for the administration of RhIg include:
-Rh(D)-negative mothers in the 28th week of pregnancy
-Following delivery of an Rh(D)-positive infant.
-Pregnant Rh(D)-negative women who are at increased risk for a feto–maternal hemorrhage in the perinatal period
-Rh(D)-positive platelets to an Rh(D)-negative woman of childbearing age
123
Administered to prevent immunization to the D antigen.
Rh Immune Globulin (RhIg)
124
RhIg is often administered intramuscularly when given in what period?
in the perinatal or postnatal period.
125
The route chosen for post-transfusion RhIg administration is often dependent on...
on the dose of RhIg that will be given.
126
______ may be used in some cases as an alternative to intravenous immunoglobulin (IVIG) for the treatment of immune thrombocytopenia (ITP).
RhIg
127
Intravenous Immune Globulin (IVIG)
-Used to treat a variety of disorders, including:
a. Primary immune deficiencies
b. Acquired immune deficiencies
c. Autoimmune disorders
d. Infectious diseases
128
Defined as replacement of a patient’s total blood volume with donor components within 24 hours
Massive Transfusion
129
Most facilities generally define massive transfusion as more than ___ red blood cell units transfused in 24 hours or less.
10
130
Adverse Transfusion Reactions:
Usually not used to describe transfusion-transmitted bacterial, viral, prion, or parasitic infections.
Ture or false?
True
-All other unintended adverse events are normally described under the umbrella term of transfusion reactions.
131
Reactions are commonly classed as acute if they occur within ___ hours of transfusion.
24
132
May present anywhere from one day to two or more weeks after transfusion.
Delayed Transfusion Reactions
133
Transfusion-Reaction Surveillance:
What are the two oldest and most well-established surveillance networks?
- Serious Hazards of Transfusion (SHOT) – a voluntary reporting scheme in the United Kingdom.
- Haemovigilance Network of the Agence française de sécurité des produits de santé (AFSSAPS) – a mandatory reporting scheme in France.
134
A biovigilance system was first proposed in the United States in 2006, a collaborative effort involving both public and private organizations. The national ___________ program, which is one of the four components that make up the complete system, was launched in 2010.
hemovigilance
- In the United States, the FDA has a guidance document that outlines steps for notifying the agency of any fatalities related to blood collection or transfusion
135
Do adverse transfusion reactions have to be rported?
No. , but any transfusion-associated fatalities area required to be reported to the Centre for Biologics Evaluation and Research (CBER) as soon as possible, with a full written report required within 7 days.
136
- One of the best known and most completely characterized adverse events in transfusion medicine.
- Most commonly associated with patient antibodies that are directed against antigens present on the transfused red blood cells.
Immune-Mediated Hemolytic Transfusion Reaction
- Pretransfusion testing and patient identification procedures have been designed primarily to prevent this reaction.
137
Immune-Mediated Hemolytic Transfusion Reaction can be divided into what two groups?
Acute hemolytic reactions
Delayed hemolytic reactions
138
The most serious acute hemolytic reactions occur as a result of patients receiving ____-incompatible red blood cells, either through misidentification of the patient, the specimen, or the blood component, or through errors in pretransfusion testing
ABO
139
Delayed hemolytic reactions are most often due to the presence of patient antibodies to...
non-ABO red blood cell antigens.
140
Symptoms of acute hemolytic reactions
Infusion site pain, hypotension, wheezing, chest pain, flushing, and gastrointestinal symptoms.
141
Acute hemolytic reactions are Characterized by blank abnormalities.
is also characterized by associated coagulation abnormalities.
142
What type of damage is associated with acute hemolytic reactions
Renal damage is a significant risk for patients experiencing an acute hemolytic reaction.
143
Laboratory diagnosis of acute hemolytic anemia
The laboratory investigation is key to
The DAT will be what
what should be ruled out
-The laboratory investigation is key to correctly diagnosing an acute hemolytic transfusion reaction, particularly a clerical check to identify any errors in patient or blood component identification.
-In most cases, the post-transfusion direct antiglobulin test (DAT) will be positive; however, a negative DAT should not rule out the diagnosis of having this type of reaction.
144
Acute hemolytic anemia transfusion reactions
The most important first step when an adverse reaction is suspected is to
stop the transfusion
145
Acute Hemolytic Transfusion Reaction
Treatment depends on what
what is used to increase urine output and improve blood flow
- Treatment depends on the amount of incompatible blood transfused and the severity of the patient’s symptoms.
- Lasix may be used to increase urine output and improve blood flow to the kidneys.
146
Acute Hemolytic Transfusion Reaction
What may be administered?
The most common cause of Acute hemolytic anemias
i. Platelets, plasma, and/or cryoprecipitate may be administered.
xii. The most common cause is a patient receiving the incorrect blood component.
147
The most important tool in preventing an acute hemolytic reaction is
i. The most important tool in preventing an acute hemolytic reaction is strict adherence to policies and procedures.
148
Acute hemolytic transfusion reactions
patients present with or without what
what is present in the urine
- Fever with or without chills
- Hemoglobinuria
149
patients with Acute hemolytic anemia will often present with
what condition correlates with acute hemolytic anemia
Dyspnea(SOB) or hypotension that can progress to shock
DIC or disseminated intravascular shock
150
Delayed hemolytic transfusion reactions
Events are often what
known to occur with much greater what
i. Events are often unrecognized and frequently go unreported.
ii. Known to occur with much greater frequency than acute hemolytic reactions.
151
Delayed Hemolytic Transfusion Reaction
Begin the same way as acute hemolytic reactions, but blank is not initiated, and reactions tend to be blank.
iii. Begin much the same way as acute hemolytic reactions; however, complement activation is not initiated or is incomplete.
iv. Reaction tends to be less severe than acute hemolytic reactions.
152
Delayed Hemoloytic Transfusion Reaction
Symptoms
reactions can progress to
i. Symptoms include fever and anemia days to weeks after transfusion along with signs of extravascular hemolysis, including jaundice, leukocytosis, and hemoglobinuria.
ii. Reaction in some patients can progress to hyperhemolysis.
153
b. Delayed Hemolytic Transfusion Reaction
Lab follow-up is key to
Treatment generally consists of
vi. Laboratory follow-up is key to diagnosing.
vii. Treatment generally consists of observation and supportive care.
154
b. Delayed Hemoloytic Transfusion Reaction
155
b. Delayed Hemolytic Transfusion Reaction
If the resulting anemia necessitates additional transfusions, then
viii. If the resulting anemia necessitates additional transfusions, red blood cells negative for the antigen(s) against which the patient’s antibody(ies) is directed must be selected in order to prevent further hemolysis.
156
b. Delayed Hemolytic Transfusion Reaction
For patients who remain unresponsive blank can be done
Errors that cause the reaction can be mitigated by what
x. For patients who remain unresponsive, a splenectomy may be indicated.
xi. Errors that cause this reaction can be mitigated by strict adherence to all policies and procedures around pretransfusion testing and blood component administration. Use of technology and automation can also reduce the risk of human error.
157
b. Delayed Hemolytic Transfusion Reaction
Complete patient history can help what
xii. A complete patient history can often help identify patients that are at an increased risk for delayed hemolytic transfusion reactions.
158
b. Delayed Hemolytic Transfusion Reaction
Testing for recently transfused or pregnant patients must be performed with samples drawn no more then.
xiii. Testing for recently transfused or pregnant patients must be performed with samples drawn no more than 3 days before planned transfusion.
159
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
The most commonly reported what
defined as a reaction that involves a increase in what
1. The most commonly reported complications associated with transfusion.
2. Defined as typical that the reaction involves an increase in body temperature of at least 33.8° F (1° C) either during or shortly after the transfusion.
160
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
What is also considered FNHTR
3. The occurrence of chills or rigor, even in the absence of fever, also is considered a FNHTR.
161
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
Reactions occurs most frequently among
4. Reaction occurs most frequently among people who have been multiply transfused or previously pregnant.
162
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
Recurrences are common after
the reaction is generally what
Recurrences are common after an initial reaction is reported. The reaction, however, is generally mild and not considered to be life-threatening.
163
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
is what type of reaction
FNHTR is a leukocyte-mediated reaction. Two known mechanisms exist:
164
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
Mechanism that involves the recipient being blank to HLA
The recipient has been alloimmumized to HLA because of exposure to foreign WBCs during pregnancy, transfusion, or transplant. The recipient’s HLA antibody attacks the transfused leukocytes that possess the concurrent antigen.
165
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
Mechanism that involves blank substances being release from what
Cytokine substances are released from leukocytes during blood product storage. The cytokines are passively transfused to the recipient and initiate an inflammatory response.
166
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
The release of what causes fever
The release of pyrons in both mechanisms cause fever
167
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
The onset of symptoms of FNHTR occurs up to or during
definitive symptoms
7. The onset of symptoms of FNHTR occurs during or up to 4 hours after transfusion. The definitive symptoms are fever >100.4° F (38° C) oral or equivalent with a change of >33.8° F (1° C) from pretransfusion value or occurrence of chills/rigors even in the absence of fever.
168
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
Secondary symptoms of FNHTR
8. Other symptoms that may be present include respiratory distress (wheezing, coughing, dyspnea), hypertension or hypotension, headache, or vomiting.
169
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
follow up testing is determined by
10. If symptoms of fever, chills, or rigor appear during transfusion, then
Because varying definitions of FNHTR exist, the criteria for diagnosis and follow-up testing are determined by each facility.
10. If symptoms of fever, chills, or rigor appear during transfusion, the transfusion should be immediately discontinued. An antipyretic (i.e., acetaminophen) can be administered to reduce fever and alleviate patient discomfort.
170
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
An antipyretic can
An antipyretic (i.e., acetaminophen) can be administered to reduce fever and alleviate patient discomfort
171
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
11. In certain circumstances, when it is likely that the fever is due to a FNHTR and not one of the life-threatening reactions, the reaction can be what
The transfusion may be restarted at a slower pace so long as the transfusion is completed within the required 4-hour timeframe. More frequent monitoring of the patient’s vital signs is often performed in these situations.
172
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
An effective method of prevention is
12. An effective method of prevention is prestorage removal of leukocytes from blood products, which reduces the likelihood of the formation of antigen–antibody complexes as well as the release of cytokine substances.
173
Febrile Nonhemolytic Transfusion Reaction (FNHTR)
Patients who are known to be susceptible to FNHTR are sometimes given an
Antipyretic prior to subsequent transfusions.
174
Allergic Transfusion Reaction
Occurs in how much of the population
Are frequently encountered during
1. Occur in 1–5% of the transfused population.
2. Are frequently encountered during the transfusion of plasma products and can be identified in combination with febrile transfusion reactions.
175
Allergic Transfusion Reaction
Typically are what within a few minutes
are caused by blank allergens
Typically are mild and occur within a few minutes of exposure to the allergen in the transfused product.
Are caused by protein-based allergens that react with preformed plasma antibodies
176
Allergic Transfusion Reaction
Symptoms
blank is required to confirm the reaction
Symptoms are mucocutaneous and initially present as urticaria. A morbilliform or measles-like rash can occur with or without pruritus. Flushing of the skin and localized edema can occur, particularly on the lips, tongue, uvula, and periorbital area around the eyes. At least two symptoms must be observed in order for the allergic reaction to be confirmed.
177
Allergic Transfusion Reaction
When symptoms appear what should be done
6. When symptoms appear, the transfusion should be stopped immediately and intravenous access should be maintained
178
Allergic Transfusion Reaction
what is given to reduce symptoms
An antihistamine such as diphenhydramine can be given orally or intramuscularly to reduce the symptoms and recipient discomfort.
179
Allergic Transfusion Reaction
The transfusion can be resumed once
they are not completely what
The transfusion can be resumed once the symptoms resolve and if the reaction was mild.
Are not completely preventable.
180
Anaphylactic/Anaphylactoid Transfusion Reaction
Are what rare allergic responses to blank?
Are rare allergic responses to plasma-containing blood products
181
Anaphylactic/Anaphylactoid Transfusion Reaction
are what type of reaction and occur within
Nonhemolytic, type I hypersensitivity reactions that occur within minutes of exposure, typically after the infusion of a few milliliters of blood.
182
Anaphylactic/Anaphylactoid Transfusion Reaction
are caused by a reaction between what and what
Protein allergen in the transfused product + corresponding antibody
183
Anaphylactic/Anaphylactoid Transfusion Reaction
Anaphylactoid.
When reactions to plasma proteins result in the production of non-IgE class antibodies with non-IgE-mediated release of mast cell mediators
184
Anaphylactic/Anaphylactoid Transfusion Reaction
Have the potential to occur in what antibody deficiency
IgA-deficient individuals when they have made antibodies to IgA after exposure to IgA through a previous transfusion or pregnancy.
185
Anaphylactic/Anaphylactoid Transfusion Reaction
What distinguishes this conditions
The absence of fever is a key feature that distinguishes these reactions from others that have similar clinical presentations.
186
Anaphylactic/Anaphylactoid Transfusion Reaction
Observable symptoms include
Severe respiratory problems, hypotension, mucocutaneous symptoms
Respiratory symptoms may be laryngeal. Pulmonary symptoms may be present.
187
Anaphylactic/Anaphylactoid Transfusion Reaction
Confirmation must include
8. Confirmation must include the rule-out of other environmental, drug, or dietary allergenic sources.
188
Anaphylactic/Anaphylactoid Transfusion Reaction
9. If reaction is suspected, then the
Transfusions are never what even if symptoms are resolved
9. If reaction is suspected, the transfusion must be stopped immediately. The transfusion is never resumed even if immediate symptoms are resolved.
189
Anaphylactic/Anaphylactoid Transfusion Reaction
Immediate medical intervention usually requires monitoring.
What should be kept open?
What is done to maintain respiratory function?
Immediate medical intervention usually requires monitoring the airway, blood volume, and blood pressure. The intravenous line should be kept open so that epinephrine and steroids, such as prednisone, can be administered. Oxygen therapy is given to maintain respiratory function. Intubation of the patient may be necessary.
190
Anaphylactic/Anaphylactoid Transfusion Reaction
Prevention is based on
Prevention is based on previous history of either a suspected or confirmed severe reaction to a plasma-containing blood product.
191
Transfusion Related Acute Lung Injury (TRALI)
Reported incidences range from as many as
is the leading cause of
Reported incidences range from as many as 1 in 1,300 transfusions to as few as 1 in 100,000.
The leading cause of transfusion-associated fatalities
192
Transfusion Related Acute Lung Injury (TRALI)
Associated most often with what from female donors
Plasma-rich products from female donors, who are more likely to make alloantibodies because of exposure through pregnancies.
193
Transfusion Related Acute Lung Injury (TRALI)
An acute adverse reaction that occurs within
Characterized by the onset of
6 hours of transfusion
Of acute hypoxemia in the absence of cardiac involvement.
194
Transfusion Related Acute Lung Injury (TRALI)
it is generally agreed that blank are involves
The ultimate result of damage is where and results in
Neutrophils are involved, with the ultimate result of damage to the pulmonary capillaries and subsequent pulmonary edema.
195
Transfusion Related Acute Lung Injury (TRALI)
is exclusively to the
pulmonary microvasculature
196
Transfusion Related Acute Lung Injury (TRALI)
First step of TRALI
a preexisting condition causes the neutrophils to congregate in the lining of the lungs
197
Transfusion Related Acute Lung Injury (TRALI)
Second step of TRALI
an immune or nonimmune process results in the onset of symptoms.
198
Transfusion Related Acute Lung Injury (TRALI)
The diagnosis is complicated by other risk factors for
acute lung injury (ALI).
199
200
The Clinical workup for diagnosis should include a
CBC= show a decrease in circulating neutrophils
Visual inspection for hemolysis
DAT
201
11. When symptoms of TRALI are evident, the transfusion must be
must be stopped immediately. The bags of all units transfused within the last 6 hours should be returned to the laboratory and the unit that was the last to be transfused should be identified.
202
13. Because, in most cases, the culprit of TRALI arises from donor antibodies in a blood component
The patient does not have to
the patient does not have to go through any workup to prevent future reactions. Subsequent transfusions from a different donor are typically acceptable.
203
E. Transfusion Related Acute Lung Injury (TRALI)
blood collection facilities have implemented the practice of selecting plasma from predominantly
male donors for transfusion because these collections are less likely to contain antibodies to neutrophils, which have often been implicated in cases of TRALI.
204
E. Transfusion Related Acute Lung Injury (TRALI)
Plasma from female donors may be diverted to
1. other purposes, such as further manufacturing into products like albumin and intravenous immune globulin (IVIG).
205
F. Transfusion-Associated Circulatory Overload (TACO)
is a rarely reported what
1. A rarely reported adverse reaction; it is believed that actual incidence is much higher because the reaction is underreported.
206
A. Transfusion-Associated Circulatory Overload (TACO)
what is the most common cause
Rapid rate of infusion of blood products
207
4. To definitively diagnose, at least three of the following symptoms must occur within 6 hours of transfusion
-Acute respiratory distress; for example, dyspnea, orthopnea (difficulty breathing except when sitting upright), cough
-Evidence of positive fluid balance
-Elevated brain natriuretic peptide (BNP)
-X-ray evidence of pulmonary edema
-Evidence of left heart failure
-Elevated central venous pressure (CVP)
208
F. Transfusion-Associated Circulatory Overload (TACO)
The clinical workup for suspected cases typically includes
electrocardiogram, pulmonary function tests, chest x-ray, monitoring of central venous pressure, and vital signs.
209
F. Transfusion-Associated Circulatory Overload (TACO)
is often confused with what
how do you differentiate
6. TRALI is often confused with TACO. Testing for brain natriuretic peptide (BNP) levels has been suggested as a noninvasive way to differentiate TACO and TRALI because BNP is elevated in TACO.
210
F. Transfusion-Associated Circulatory Overload (TACO)
7. If TACO is suspected then
the transfusion should either be stopped immediately or the rate of transfusion significantly slowed if the transfusion is vital.
211
F. Transfusion-Associated Circulatory Overload (TACO)
Patients may be placed in an upright position to help with
supportive treatment includes what
respiratory distress and supportive treatment often includes oxygen therapy.
212
F. Transfusion-Associated Circulatory Overload (TACO)
Diuretics may be given what to increase urinary output and reduce blood volume
??
213
F. Transfusion-Associated Circulatory Overload (TACO)
10. If severe symptoms persist then
10. If severe symptoms persist, therapeutic phlebotomy can be used to rapidly reduce blood volume.
214
F. Transfusion-Associated Circulatory Overload (TACO)
TACO is prevented by identifying patients in
high-risk groups and taking appropriate measures to limit the rapid expansion of blood volume during transfusion
215
G. Transfusion-Associated Dyspnea (TAD)
1. Term that describes transfusion reactions when a patient experienced respiratory distress but when TRALI, TACO, and other causes have been ruled out.
216
Hypotensive Transfusion Reactions
Definition
1. Identified as a drop in blood pressure (systolic or diastolic) of >30 mm Hg that occurs during or within 1 hour after the transfusion.
217
Hypotensive Transfusion Reactions
The diagnosis is often difficult because
many adverse reactions to transfusion include symptoms of hypotension.
218
Hypotensive Transfusion Reactions
what is the most common blood component implicated
4. Platelet units are the most common blood component implicated
219
Hypotensive Transfusion Reactions
hypotensive reactions are related to
5. Hypotensive reactions are related to bradykinin function and metabolism. Bradykinin is a peptide, produced naturally in the body by the kinin–kallikrein system of blood proteins. Bradykinin causes vasodilation and subsequent lowering of blood pressure.
220
Hypotensive Transfusion Reactions
Bradykinin
Bradykinin is a peptide, produced naturally in the body by the kinin–kallikrein system of blood proteins. Bradykinin causes vasodilation and subsequent lowering of blood pressure.
221
Hypotensive Transfusion Reactions
6. In order to diagnose a hypotensive transfusion reaction what is essential
that other adverse reactions characterized by symptoms of hypotension are excluded.
222
7. When hypotensive transfusion reactions are suspected, what must be discontinued
what is the medicine for treatment
the transfusion must be discontinued immediately. Treatment, including vasopressors to increase blood pressure, can be administered to offset symptoms.
223
Hypotensive Transfusion Reactions
Reaction can be prevented by
discontinuing ACE inhibitor treatment for a period of time before blood transfusion is administered.
The elimination of bedside leukoreduction filters is also recommended.
224
Transfusion-Associated Graft versus Host Disease (TA-GVHD)
mortality rate is
death occurs when
A rare complication of transfusion, but the mortality rate is approximately 90%.
Death occurs rapidly, within 1–3 weeks of onset.
225
Transfusion-Associated Graft versus Host Disease (TA-GVHD)
Caused by
Caused by donor T-cell lymphocytes from transfused blood products that are able to recognize the host (or recipient) cells as a result of differences in human leukocyte antigens (HLAs). The donor T-cell lymphocytes attack the host’s tissues that carry the different HLA.
226
Transfusion-Associated Graft versus Host Disease (TA-GVHD)
blank states interfere with the recipients ability to eliminate the donor lymphocytes predispose transfusion recipients to developing TA-GVHD.
Certain immunodeficient states that interfere with the recipient’s ability to eliminate the donor lymphocytes predispose transfusion recipients to developing TA-GVHD.
227
Transfusion-Associated Graft versus Host Disease (TA-GVHD)
symptoms
symptoms occur when
Symptoms typically occur within a few days to approximately 6 weeks after transfusion.
Symptoms include fever, body rash, enlarged liver, and diarrhea
228
Transfusion-Associated Graft versus Host Disease (TA-GVHD)
7. The diagnosis may not always be immediately evident because
of its rarity, the delay from transfusion to onset of symptoms, and the general symptoms of rash and diarrhea are not necessarily specific to TA-GVHD.
229
Transfusion-Associated Graft versus Host Disease (TA-GVHD)
Gamma irradiation is effective in
There is no
Gamma irradiation is effective in preventing and acts by inactivation of donor lymphocytes, inhibiting their ability to proliferate in the host.
standard therapy
230
Hemosiderosis is known as
iron overload
231
Hemosiderosis
Is an adverse response to
An adverse response to multiple (usually > 100) red blood cell transfusions.
232
Hemosiderosis
A concern in what type of transfused patient
chronically transfused patients such as sickle cell disease or thalassemia patients and less commonly occurring patients are hereditary hemolytic anemias and hemoglobinopathies are also at risk.
233
Hemosiderosis
overall incidence is
symptoms include
Laboratory findings of
- Overall incidence is low.
- The physical symptoms include weakness and fatigue.
- Laboratory findings of jaundice, anemia, and cardiac arrhythmia are often present.
234
Hemosiderosis
If left untreated it can lead to
liver and/or heart failure.
235
Hemosiderosis
Prevention is best achieved by
Iron toxicity can be prevented by
Iron toxicity can be prevented, delayed, or treated with iron chelation therapy.
Prevention is best achieved by limiting transfusion of red blood cell products.
236
Post-Transfusion Purpura (PTP)
majority of cases occurs in
females over the age of 60
236
Post-Transfusion Purpura (PTP)
Presents with life threating
thrombocytopenia.
237
Post-Transfusion Purpura (PTP)
main cause of death
Cerebral hemorrhage
238
Post-Transfusion Purpura (PTP)
what has decreased the incidence over the past several years
Transfusion of leukoreduced blood products has decreased the incidence over the past several years.
239
Post-Transfusion Purpura (PTP)
the majority of cases involve
antigen-negative patients who develop alloantibodies after exposure to platelet antigens through pregnancy or transfusion.
240
Post-Transfusion Purpura (PTP)
what is the classic presentation
and the disease tends to
Wet purpura
resolve on its own.
241
Post-Transfusion Purpura (PTP)
Treatment methods for managing PTP include
intravenous immune globulin, plasmapheresis, high-dose steroids, and splenectomy. Intravenous immune globulin is currently considered the treatment of choice.
242
Post-Transfusion Purpura (PTP)
treatment method of choice
Intravenous immune globulin is currently considered the treatment of choice.
243
K. Post-Transfusion Purpura (PTP)
Platelet transfusions are not
recommended for treatment of PTP because the transfused platelets will be destroyed.
244
K. Post-Transfusion Purpura (PTP)
Although recurrence of PTP is rare even for those patients with a confirmed history, what is recommended still
antigen-negative platelets are recommended for future transfusions
245
Reactions Associated with Massive Transfusion
The following transfusion reactions are most commonly associated with rapid transfusion of large amounts of blood products
-Citrate toxicity
-Hypothermia
-Dilutional coagulopathy
246
Nonimmune hemolysis
Several conditions, both physical and chemical in origin, can cause
red blood cells to hemolyze prior to transfusion.
247
Nonimmune hemolysis
symptoms
248
Nonimmune hemolysis
symptoms may be subtle but include what
Absence of blank is common
1. Symptoms may be subtle but typically include chills, hypotension, hemoglobinuria, and shortness of breath.
2. Absence of fever is a common finding in both physical and chemical types of hemolysis.
249
Nonimmune hemolysis
The differential diagnosis requires
the initial rule-out of immune hemolytic transfusion reaction (either immediate or delayed) or intrinsic defects in either the donor or recipient red blood cell membrane.
250
Nonimmune hemolysis
When suspected, the transfusion should be
be stopped and the intravenous line kept open. Cardiac and respiratory function should be monitored
251
Nonimmune hemolysis
Is best prevented through
Is best prevented through adherence to written protocols and standards.
252
Initial Laboratory Investigation of Suspected Transfusion Reaction
Because many types of transfusion reactions demonstrate similar symptoms it is critical that
it is critical that a complete follow-up and investigation be performed on every reported reaction.
253
Initial Laboratory Investigation of Suspected Transfusion Reaction
When investigating a transfusion reaction both what are critical
both the clinical evaluation and the laboratory work-up are critical to correctly diagnosing the etiology of the reaction
254
Initial Laboratory Investigation of Suspected Transfusion Reaction
Depending on the symptoms and the patient history, the laboratory may request that
any remaining blood component, along with the infusion tubing, be forwarded to the laboratory along with a post-transfusion blood sample for investigation.
255
Initial Laboratory Investigation of Suspected Transfusion Reaction
Intial Laboratory investigation includes
Initial laboratory investigation includes a clerical check for errors on the pretransfusion specimen label, initial laboratory requisition, other paperwork, pretransfusion testing results, component tags and labels, and the post-transfusion specimen label.
256
Initial Laboratory Investigation of Suspected Transfusion Reaction
The pre- and post-transfusion samples are visually inspected for
a DAT is preformed on what sample
for signs of hemolysis, although low levels in free hemoglobin may not be visible to the naked eye, and a direct antiglobulin test (DAT) is performed on the post-transfusion sample.
257
The period beginning as early as the 20th week of gestation or as late as the 28th week of pregnancy and ending 28 days after birth.
Perinatal
258
Newborn from birth to 4 weeks of age.
Neonate
259
For transfusion purposes, neonates are babies who are ____ months old or less and infants are babies over ____ months of age.
4 months
4 months
260
Number of pregnancies experienced by a woman regardless of whether they resulted in a birth or not.
Gravida
261
Delivery of a live infant.
Para
262
The shortened lifespan of fetal or neonatal red blood cells caused by the action of maternal antibodies attaching to corresponding antigens on the baby’s red blood cells (RBCs).
Hemolytic Disease of the Fetus and Newborn (HDFN)
263
Conditions that Cause Red Blood Cell Hemolysis in the Fetus or Newborn
1. Genetic red blood cell membrane defects, enzyme deficiencies, or hemoglobinopathies:
Glucose-6-phosphate dehydrogenase deficiency
Pyruvate kinase deficiency
Thalassemia
Hereditary spherocytosis
Hereditary elliptocytosis
Disorders of hemoglobin synthesis
264
Conditions that Cause Red Blood Cell Hemolysis in the Fetus or Newborn:
Acquired defects of the red blood cells secondary to infection:
Toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH)
Parvovirus B19
Syphilis
265
Stages of Pathogenesis of HDFN
1. Step 1: Exposure of the mother to fetal RBC antigens with subsequent production of blood group antibodies (anti A,B is an exception that does not require previous exposure to RBC antigens).
2. Step 2: Placental transfer of the maternal antibodies to the fetus with attachment to fetal RBC antigens.
3. Step 3: Subsequent immune destruction of the antibody-coated fetal red blood cells.
4. Step 4: Clinical manifestations resulting from the destruction of these marked red blood cells
266
Conditions Necessary for Maternal Antibody Formation in Hemolytic Disease of the Fetus and Newborn
1. The mother must lack the antigen present on the fetal RBCs
2. The fetal antigen must be well developed in utero
3. The mother is exposed to the fetal antigen
4. The mother produces an IgG antibody to the antigen, capable of crossing the placenta
267
Three sensitization-related aspects associated with laboratory testing of a mother suspected of having HDFN include:
-Antigens
-Immunoglobulin class
-Influence of ABO groups
268
Transfusion-Transmitted Infections
Hepatitis A
What type of virus is it, and the family
1. Small, nonenveloped RNA virus in the Picornaviridae family
269
Transfusion-Transmitted Infections
Hepatitis A
How is it transmitted?
Is it the most common hepatitis virus
- Transmitted when unsanitary conditions result in contaminated food or water, which is then ingested.
The most common of all the hepatitis viruses.
Ttransmitted mainly through the fecal–oral route
270
Transfusion-Transmitted Infections
Hepatitis A
Incubation period and symptoms
The incubation period is about 4 weeks.
Symptoms include fatigue, fever, jaundice, and vomiting
271
Transfusion-Transmitted Infections
Hepatitis A
The period of active infection usually lasts less than blank , and there is no know blank
The period of active infection usually lasts less than blank, and there are no known Chronic carrier states.
272
Transfusion-Transmitted Infections
Hepatitis A
Most common fatalities cause
Transmissible through
Rare fatalities have been documented, mainly in older adults or those with preexisting liver disease.
Transmissible through blood transfusion, although rare.
273
Transfusion-Transmitted Infections
Hepatitis B
Type of virus and family
An enveloped DNA virus in the Hepadnaviridae family
274
Transfusion-Transmitted Infections
Hepatitis B
Prevalence
transmission
Prevalence in the United States has decreased during the last couple of decades as a result of available vaccination.
Can be transmitted sexually, parenterally, and vertically.
275
Transfusion-Transmitted Infections
Hepatitis B
Percutaneous transmission can occur by
Breaking the skin with contaminated sharp objects such as surgical instruments and phlebotomy needles.
276
Transfusion-Transmitted Infections
Hepatitis B
how long can the virus survive in dried blood
1 week
277
Transfusion-Transmitted Infections
Hepatitis B
symptoms
flu-like symptoms, jaundice, and elevated liver enzymes and present after a 2- to 6-month incubation period.
278
Transfusion-Transmitted Infections
Hepatitis B
A small percentage of long-term carriers of HBV will progress to
Chronic disease
279
Transfusion-Transmitted Infections
Hepatitis B
Complications of chronic infection include
Cirrhosis of the liver and hepatocellular carcinoma, which together cause most of the fatalities associated with HBV.
280
Transfusion-Transmitted Infections
Hepatitis B
8. HBV is a blank virus and is transmitted through blank
HBV is a plasma-borne virus that is easily transmitted through all blood components and most products. The risk of transmission is highest when plasma is pooled for the manufacture of plasma products and derivatives.
281
Transfusion-Transmitted Infections
Hepatitis B
The current risk in the US of HBV infection from a transfusion is
1:220,000
282
Transfusion-Transmitted Infections
Hepatitis C
Type of virus and family
Small, enveloped RNA virus in the Flaviviridae family
283
Transfusion-Transmitted Infections
Hepatitis C
Prevalence
Prevalent in the United States, with more than 20,000 new cases each year and 3 million chronic carriers.
284
Transfusion-Transmitted Infections
Hepatitis C
Transmission
Intravenous drug use and sharing of needles between partners are the most common sources of transmission. Sexual and placental transmissions are possible; however, they are uncommon.
285
Transfusion-Transmitted Infections
Hepatitis C
Most acute cases are
asymptomatic
286
Transfusion-Transmitted Infections
Hepatitis C
symptoms
Symptoms include jaundice and elevated liver enzymes that indicate changes in liver function.
287
Transfusion-Transmitted Infections
Hepatitis C
% of chronic carriers
Approximately 80% of persons infected with HCV become chronic carriers
288
Transfusion-Transmitted Infections
Hepatitis C
Long term risk
The long-term risk of chronic carrier status includes cirrhosis of the liver and hepatocellular carcinoma.
289
Transfusion-Transmitted Infections
Hepatitis D
type of virus and family
small RNA virus( delta virus)
family: not classified because dependent on HBV
290
Transfusion-Transmitted Infections
Hepatitis D
Transmission
Transmitted mainly through parenteral and sexual routes, but only in the presence of HBV.
291
Transfusion-Transmitted Infections
Hepatitis D
Coinfection
People with hepatitis B and hepatitis D co-infection experience a more severe, acute illness than those infected with hepatitis B alone.
292
Transfusion-Transmitted Infections
Hepatitis D
Assays
Assays to detect antibodies to HDV are available; however, blood donor screening for HDV is not recommended because the elimination of hepatitis B–positive donors eliminates the risk of HDV transmission.
293
Transfusion-Transmitted Infections
Hepatitis E
Type of virus and family
Nonenveloped RNA virus in the Hepeviridae family
294
Transfusion-Transmitted Infections
Hepatitis E
Transmission
Transmitted mainly through the fecal–oral route. It is not known to be sexually transmitted
295
Transfusion-Transmitted Infections
Hepatitis E
Illness usually involves a
The illness usually involves a mild form of hepatitis, and few fatalities have been reported from complications of liver disease
296
Transfusion-Transmitted Infections
Hepatitis E
Most cases are
Most cases are acute and do not proceed to a chronic illness.
297
Transfusion-Transmitted Infections
Hepatitis E
area of infection from transfusion
Serologic testing
Rare transfusion transmission of HEV from infected donors has been reported in countries outside of the United States.
Serologic tests for HEV are available; however, blood donor screening for HEV is not recommended because transmission in the United States is unsubstantiated
298
Transfusion-Transmitted Infections
Hepatitis G
Also called what
Family and type of virus
-Also called GB virus
-Enveloped RNA virus in the Flaviviridae family.
299
Transfusion-Transmitted Infections
Hepatitis G
Transmission
Although HGV is transmitted through blood transfusion, the virus does not appear to cause disease in humans.
300
Transfusion-Transmitted Infections
Hepatitis G
Does not cause
hepatitis-like illness
301
Transfusion-Transmitted Infections
Hepatitis G
Assays
Although assays for the identification of HGV are available, blood donor screening for HGV is not recommended because of the lack of an associated disease state.
302
Transfusion-Transmitted Infections
Retroviruses:
Human Immunodeficiency Virus (HIV) I and II
Type of virus and family
Enveloped virus in the Retroviridae family. HIV is composed of an outer envelope of proteins around an inner core of RNA and reverse transcriptase enzyme.
303
Transfusion-Transmitted Infections
Retroviruses:
Human Immunodeficiency Virus (HIV) I and II
The subtypes of HIV-I and II share up to
50% of their genetic sequence; this creates the potential for cross-reactivity during testing.
304
Transfusion-Transmitted Infections
Retroviruses:
Human Immunodeficiency Virus (HIV) I and II
Prevalence
HIV-I is prevalent worldwide, and HIV-II is endemic in western Africa.
305
Transfusion-Transmitted Infections
Retroviruses:
Human Immunodeficiency Virus (HIV) I and II
HIV is mainly concentrated in
Plasma
306
Transfusion-Transmitted Infections
Retroviruses:
Human Immunodeficiency Virus (HIV) I and II
5. Both HIV-I and II are the causative agents of
Acquired immunodeficiency syndrome (AIDS).
307
Transfusion-Transmitted Infections
Retroviruses:
Human Immunodeficiency Virus (HIV) I and II
HIV is transmitted
Parenterally, sexually, vertically, and through breast milk.
308
Transfusion-Transmitted Infections
Retroviruses:
Human Immunodeficiency Virus (HIV) I and II
7. Approximately 40% of people that are infected with HIV exhibit
Flu-like symptoms, with the remainder of infections being asymptomatic for 10 years or longer.
309
Transfusion-Transmitted Infections
Retroviruses:
Human Immunodeficiency Virus (HIV) I and II
The combined strategies of donor deferral, confidential self-exclusion, and transmissible disease testing have reduced blank.
The overall risk of transfusion-transmitted HIV I/II to 1:2,000,000.
310
Transfusion-Transmitted Infections
Retroviruses:
Human T-Cell Lymphotrophic Virus (HTLV) I and II
Type of virus
1. Delta retroviruses
311
Transfusion-Transmitted Infections
Retroviruses:
Human T-Cell Lymphotrophic Virus (HTLV) I and II
A very small percentage of HTLV-infected people develop either
the rare adult T-cell leukemia/lymphoma (ATL) or a demyelinating neurologic disorder known as HTLV-associated myelopathy (HAM) or tropical spastic paraparesis.
311
Transfusion-Transmitted Infections
Retroviruses:
Human T-Cell Lymphotrophic Virus (HTLV) I and II
Type one is endemic in
Certain parts of Japan, South America, the Caribbean, and Africa.
311
Transfusion-Transmitted Infections
Retroviruses:
Human T-Cell Lymphotrophic Virus (HTLV) I and II
HTLV is transmissible through
blood transfusion and is capable of inducing active infection in a recipient.
311
Transfusion-Transmitted Infections
Retroviruses:
Human T-Cell Lymphotrophic Virus (HTLV) I and II
4. HTLV II makes up about blank % of cases in the US and what group of people are most likely to get it
50% and is particularly among drug abusers.
311
Transfusion-Transmitted Infections
Retroviruses:
Human T-Cell Lymphotrophic Virus (HTLV) I and II
Modes of transmission
The modes of transmission are parenteral and sexual, and through breast milk.
311
Transfusion-Transmitted Infections
Retroviruses:
Human T-Cell Lymphotrophic Virus (HTLV) I and II
6. Active infection is usually
Asymptomatic and infection is life-long
312
Transfusion-Transmitted Infections
Retroviruses:
Human T-Cell Lymphotrophic Virus (HTLV) I and II
11. Refrigeration and storage of red blood cell products for more than 10 days results in blank
Degradation of the lymphocytes and a drop in viral load that subsequently reduces the likelihood of transmission.
313
Transfusion-Transmitted Infections
Retroviruses:
Human T-Cell Lymphotrophic Virus (HTLV) I and II
Leukocyte reduction of red blood cell products is also recommended to
minimize the incidence of transfusion-transmitted HTLV
314
Parvovirus B19
the only Known
pathogenic human parvovirus
315
Parvovirus B19
type of virus and infects what therefore classified as
-Nonenveloped single DNA virus.
-Infects red blood cells and therefore is classified as an erythrovirus.
316
-Parvovirus B19
Mainly transmitted through
the respiratory route by way of aerosols.
317
Parvovirus B19
causes a common
Parvovirus causes a common childhood illness called erythema infectiosum or fifth disease.
318
Parvovirus B19
Approximately 50% of adults have been exposed to
parvovirus with no complications.
319
Parvovirus B19
Persons at risk for complications from parvovirus include
Immunocompromised patients, pregnant women, and people with reduced RBC lifespan such as in sickle cell disease or other hemoglobinopathies.
320
Parvovirus B19
Parvovirus is transmitted mainly in
Plasma products and to a lesser extent, red blood cell products.
321
Parvovirus B19
It is resistant mainly to
common methods of pathogen inactivation including both heat treatment and solvent detergent.
322
Parvovirus B19
There is currently no screening protocol for
Parvovirus among blood donors.
323
Epstein-Barr Virus (EVB)
Member of the
Herpesviridae family
324
Epstein-Barr Virus (EVB)
Exposure rate
In the United States, approximately 95% of the adult population over age 40 has been exposed to EBV
325
Epstein-Barr Virus (EVB)
Mainly acquired through
through contact with infected saliva aka kissing disease
326
Epstein-Barr Virus (EVB)
Causative agent
infectious mononucleosis
327
Epstein-Barr Virus (EVB)
can be asymptomati or can demonstrate Symptoms of
demonstrate symptoms of sore throat, enlarged lymph nodes, fever, lethargy, and malaise.
327
Epstein-Barr Virus (EVB)
Whos at increased risk for complications from EBV infection and several lymphomas have a correlation with EBV infection.
7. Immunocompromised people
328
Epstein-Barr Virus (EVB)
Infects
B lymphocytes that can result in latent infection that lasts throughout life.
329
Epstein-Barr Virus (EVB)
8. A few cases of transfusion-transmitted of blank have been reported
EBV
330
Epstein-Barr Virus (EVB)
there is no screening protocol for
EBV detection among blood donors
331
Epstein-Barr Virus (EVB)
To prevent complications from transfusion-transmitted EBV, it is recommended that.
Seronegative individuals that are immunocompromised receive leukocyte-reduced blood products.
Some transfusion facilities will also test donors of products for immunocompromised seronegative recipients for EBV antibodies.
332
Cytomegalovirus (CMV)
Type of virus and family
DNA virus that is a member of the Betaherpesvirinae subfamily.
333
Cytomegalovirus (CMV)
Exposure rates for adults
adults in the United States rates range between 50% and 85%.
334
Cytomegalovirus (CMV)
transmission
The mode of transmission is through direct contact of blood and body fluids with infected leukocytes.
335
Cytomegalovirus (CMV)
Transmission is through
direct contact of blood and body fluids with infected leukocytes.
336
Cytomegalovirus (CMV)
Typically causes a
Mild or asymptomatic illness in healthy individuals.
337
Cytomegalovirus (CMV)
After initial infection, CMV can remain latent for
several years and become reactive later in life.
338
Cytomegalovirus (CMV)
It can cause severe and potentially life-threatening complications in
high-risk groups
339
Cytomegalovirus (CMV)
Individuals who are at risk for complications from CMV infection include those who are
immunosuppressed, including low birth weight neonates and cellular or solid organ transplant recipients.
340
9. CMV is detectable through immunological techniques including
ELISA, fluorescence assay, hemagglutination, and latex agglutination.
341
CMV
10. Although it is not possible to completely eliminate the incidence of transfusion-transmitted CMV blank reduction has significantly reduced the number of reported cases.
leukocyte reduction
342
West Nile Virus (WNV)
343
West Nile Virus (WNV)
Type of virus and family
Single-strand enveloped RNA virus of the Flaviviridae family.
344
West Nile Virus (WNV)
Found primarily in
bird species but can also be found in other animals, including horses and cattle.
345
West Nile Virus (WNV)
Transmitted to humans through
infected mosquitoes
346
West Nile Virus (WNV)
Eighty percent of humans infected with WNV are
Asymptomatic.
347
West Nile Virus (WNV)
6. People with symptomatic infection, called blank develop what
WNV fever, develop flu-like symptoms that include fever, rash, headache, and vomiting.
348
West Nile Virus (WNV)
Symptoms usually last from
usually last from 3 to 6 days and only supportive care is needed. Rare complications, in as few as 0.7% of WNV infections, include encephalitis and meningitis.
349
West Nile Virus (WNV)
In people over age 50, there is an increased risk of
long-term neurological symptoms
350
West Nile Virus (WNV)
Transmissible through
blood products
351
West Nile Virus (WNV)
In 2003 what happened
a screening test was developed and added to blood donor testing.
352
Human Herpes Virus 6 (HHV6)
Viral agent that causes
Common childhood illness that is transmitted by
roseola infantum or sixth disease.
transmitted mainly through the respiratory route.
353
Human Herpes Virus 6 (HHV6)
Prevalent in the
not known to be transmissible through
The general population and most adults have had previous exposure to the virus.
*** Not known to be transmissible through blood transfusion.
354
Human Herpes 8 HHV8
Associated with
Transmitted by
Kaposi’s sarcoma and not a common virus in the general population.
Transmitted parenterally and is present in blood, saliva, and semen.
355
Human Herpes Virus 8 HHV8
% of blood donors in the United States are seropositive for HHV-8.
3-5%
356
Human Herpes Virus 8 HHV8
Transmission may be a concern in
immunosuppressed patients
357
Human Herpes Virus 8 HHV8
Testing
At the present time, testing for HHV-8 among blood donors is not recommended.
358
SEN Virus
Family and type of virus
Nonenveloped DNA virus in the Circoviridae family.
359
SEN Virus
There is a high prevalence of SEN-V among
Transfusion recipients and the virus is known to be transmitted through blood transfusion.
360
SEN Virus
Since there is no known disease association, screening of blood donors for SEN-V is
Not recommended
361
Torque Teno Virus (TTV)
Prevalence
1. Found in the general population and has been identified in approximately 10% of blood donors in the United
362
Torque Teno Virus (TTV)
Transmission and disease association
2. Although it is known to be transmitted through blood and body fluids, no disease association for TTV has been established.
363
Torque Teno Virus (TTV)
Screening of blood donors for TTV is
not currently recommended.
364
Prions
Description of infection
1. Refers to infectious self-regulating proteins that convert normal proteins into abnormal structures.
365
Prions
Group of diseases is called
transmissible spongiform encephalitis (TSE), with different disease names being applied to different species of affected animals.
366
Prions
Prion diseases typically affect the
brain and neurologic function when abnormal protein aggregates cause sponge-like lesions in brain tissue.
367
Prions
Human diseases
Creutzfeld-Jakob disease (CJD)
Variant Creutzfeld-Jakob disease (vDJD)
Kuru
Gerstmann–Straussler–Scheinker syndrome (GSS)
Fatal familial insomnia (FFI)
368
Prions
Cattle disease
Bovine spongiform encephalopathy (BSE; “mad cow disease”)
369
Prions
sheep/goat diseases
Scrapie
370
Prions
Greater kudu/nyala diseases
Exotic ungulate encephalopathy (EUE)
371
Prions
Mink diseases
Transmissible mink encephalopathy (TME)
372
Prions Cat diseases
Feline spongiform encephalopathy
373
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
1. Creutzfeldt-Jakob disease (CJD)
It can be transmitted through
Human growth hormone products from human pituitary glands (no longer allowed), intravenous immunoglobulin (IVIG), infected electrodes for EEGs, cannibalism, and some transplant materials.
374
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
1. Creutzfeldt-Jakob disease (CJD)
There is also a known hereditary component but is
which is rare, and sometimes the etiology remains unknown especially given the long incubation period.
375
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
1. Creutzfeldt-Jakob disease (CJD)
Incubation period
can last anywhere from 4 to 20 years and very few patients exhibit symptoms before age 50.
376
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
1. Creutzfeldt-Jakob disease (CJD)
Onset of symptoms
Is sudden and often includes rapidly progressing dementia, poor coordination, visual problems, and involuntary movements.
377
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
1. Creutzfeldt-Jakob disease (CJD)
All cases are eventually
fatal, with death usually occurring within 1 year of the onset of symptoms.
378
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
1. Creutzfeldt-Jakob disease (CJD)
There have been no confirmed cases of
Transmission of CJD through blood products. Blood donor screening for CJD is not currently recommended.
379
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
Variant Creutzfeldt-Jakob disease (vCJD)
type of disease and different from what
Fatal neurological disease.
Different from CJD in terms of disease progression
380
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
Variant Creutzfeldt-Jakob disease (vCJD)
age of infection
Patients with vCJD are usually younger than 40 years old, whereas classic CJD is primarily a disease of older adults.
381
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
Variant Creutzfeldt-Jakob disease (vCJD)
The outbreak of the new disease has been linked to
has been linked to the eating of infected beef after a change in the disinfectant used to clean slaughter houses
382
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
Variant Creutzfeldt-Jakob disease (vCJD)
In contrast to classic CJD, vCJD is transmissible through
blood transfusion
383
Prions: Diseases Associated with Creutzfeld-Jakob Disease (CJD)
Variant Creutzfeldt-Jakob disease (vCJD)
Because the disease is eventually blank
Fatal, several strategies have been implemented in the United States and other countries to reduce the risk of transmission of vCJD through infected blood products.
384
Bacterial Contamination of Blood Products
Bacterial Contamination of Donor Blood
Transmission
a. A rare occurrence.
b. Reports of transfusion-transmitted bacteremia indicate that most blood component contamination occurs during venipuncture at time of collection or during the manufacture and handling of blood components.
385
Bacterial Contamination of Blood Products
Bacterial Contamination of Donor Blood
The most frequently identified causes of contamination are
poor disinfection of the venipuncture site or improper handling of an open product, for example, if the bag or vial has a crack or a broken seal.
386
Bacterial Contamination of Blood Products
Bacterial Contamination of Donor Blood
Transfusion of bacterially contaminated blood components causes
sepsis in the recipient.
386
Bacterial Contamination of Blood Products
Bacterial Contamination of Donor Blood
Regardless of the cause, bacterial contamination of blood products is associated with a
high incidence of morbidity and mortality and therefore poses a serious health threat.
387
Bacterial Contamination of Blood Products
Bacterial Contamination of Donor Blood
blank are most frequently implicated in transfusion-transmitted bacteremia.
Platelet products
387
Bacterial Contamination of Blood Products
Bacterial Contamination of Donor blood
g. While donors may have no symptoms or only minor symptoms and a low bacteremia. patients can have
severe transfusion reactions (sometimes fatal) to the bacteria and endotoxin present within blood products at the time of transfusion
388
Bacterial Contamination of Blood Products
Bacterial Contamination of Donor blood
Two bacterial diseases with a known history of being transmitted through blood products include
syphilis and Lyme disease.
389
Associated Bacterial Diseases
Syphilis
Caused by and spread through
i. Caused by the spirochete Treponemia pallidum.
ii. Most commonly spread through sexual contact
390
Associated Bacterial Diseases
Syphilis
Transfusion transmitted is
Incubation period
iii. Transfusion-transmitted syphilis is rare.
iv. The incubation period for infected persons is from 4 weeks to 5 months.
391
Associated Bacterial Diseases
Syphilis
Treat with
donor with syphilis cant
v. Active infection is readily treated with antibiotics( penicillin)
vi. Donors with a positive test for syphilis are deferred from donating blood for 12 months.
392
Associated Bacterial Diseases
Lyme disease
Caused by
Spread by a
i. Caused by the spirochete Borrelia burgdorferi.
ii. Bacterial illness that is spread by a tick bite.
393
Associated Bacterial Diseases
Lyme disease
prevalence in the US
iii. In the United States, no cases of transfusion-transmitted Lyme disease have been reported, but the disease is present in the general population and in the donor population.
394
Lyme disease
Blood donors who have a history of Lyme disease can donate if they have
no visible symptoms, have completed a full course of antibiotics, and have been cleared to donate by a physician.
395
Lyme disease
v. Screening of blood donors for Lyme disease as part of the
the transmissible disease test process is not currently recommended.
396
Parasitic infection
a. Babesiosis
caused by
Babesia microti.
397
Parasitic Infections
Babesiosis
transmitted to
ii. Transmitted to humans through tick bites, specifically from the Ixodes tick, which is also called the deer tick.
398
Parasitic Infections
Babesiosis- Common in the United States, particularly
The Northeast during warm-weather seasons when ticks are likely to be abundant.
399
Babesiosis
Although many cases are asymptomatic,
A symptomatic person will experience fever, chills, lethargy, and, in some cases, hemolytic anemia. In rare cases, the disease may be fatal.
