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BMS 185 Lecture > Quiz 8 > Flashcards

Quiz 8 Flashcards

11.30.22

1
Q

How does the Febrile transfusion reaction algorithm work?

A
  1. Patient Fever
  2. Lab evaluation:
    2a. clerical check
    2b. hemolysis
    3a. If positive DAT and hemolysis, Acute/delayed hemolytic reaction
    3b. if negative DAT and hemolysis, Check other vitals
    3b1. Increased BP, Fever, hot by 1 or 2C, chills discomfort = FNHTR
    3b2. Decreased BP, dyspnea, Pulmonary Edema Fever, hot by 1 or 2C = TRALI?
    3b3. Decreased BP, Fever of 40C or (103.5F), SOB w/ negative CXR = Bacterial Contamination Shock!
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2
Q

What indicates Acute/delayed hemolytic reaction?

A

If a patient has positive DAT and hemolysis

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3
Q

What are symptoms of TRALI?

A
  1. Negative DAT and hemolysis
  2. decreased BP
  3. Fever of increased by 1 or 2C
  4. chills
  5. discomfort
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4
Q

What are symptoms of Bacterial Contamination Shock?

A
  1. negative DAT and hemolysis
  2. Decreased BP
  3. Fever of 40C or (103.5F)
    4.(No) SOB w/ negative CXR
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5
Q

What are Hypotensive Reactions?

A

Sudden drop in systolic or diastolic blood pressure of more than 30 points seen soon after starting the transfusion

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6
Q

Who would have Hypotensive Reactions?

A
  1. platelet transfusions in patients who are on ACE (angiotensin-converting enzyme- for hypertension) inhibitors
  2. and are being transfused through negatively-charged filters (to a lesser extent with positively-charged filters)
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7
Q

What is the suggested pathophysiology of Hypotensive Reactions?

A
  1. activation of the intrinsic pathway of coagulation via Factor XII contact with the filter surface
  2. Activated Factor XII converts prekallikrein to kallikrein which cleaves HMWK to form bradykinin
  3. ACE inhibitors prevent breakdown of bradykinin
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8
Q

How to prevent Hypotensive Reactions?

A
  1. Discontinue ACE inhibitors if necessary
  2. Use of prestorage leukoreduced blood
  3. Not seen much now since almost whole U.S. is transfusing prestorage leukoreduced blood
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9
Q

What is Post Transfusion Purpura?

A

Thrombocytopenia occurring 1-2 weeks after transfusion in a patient who has made anti-platelet alloantibodies as a result of pregnancy or previous transfusion

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10
Q

Who can get Post Transfusion Purpura?

A
  1. Occurs almost exclusively in multiparous women
  2. May occur after transfusion of red cells or platelets
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11
Q

What are clinical manifestations of Post Transfusion Purpura?

A
  1. Hematuria (blood in the urine)
  2. melena (dark stools from blood in the GI tract)
  3. vaginal bleeding
  4. purpura
  5. Thrombocytopenia may be severe (below 10,000/µL)
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12
Q

What is the most frequent antibody specificity in Post Transfusion Purpura?

A

anti-HPA-1a

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13
Q

What is the pathophysiology of Post Transfusion Purpura?

A
  1. Individuals become sensitized to foreign platelet antigens from exposure during pregnancy or from a previous blood transfusion
  2. Platelet alloantibody attaches to its antigen on the platelet surface with destruction by splenic and liver macrophages
  3. Transfused platelets as well as patient’s own antigen-negative platelets are destroyed
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14
Q

What is the pathophysiology of the postulates in Post Transfusion Purpura?

A
  1. Immune complexes form and attach to autologous platelets with destruction as “innocent bystanders”
  2. Production of autoantibody in response to incompatible transfusion
  3. Soluble antigen in donor plasma adsorbs onto the recipient platelets, converting them to antigen positive platelets
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15
Q

How do you manage Post Transfusion Purpura?

A
  1. Severity of the thrombocytopenia demands action especially if the patient is bleeding, otherwise condition is self-limited
  2. Steroids, IVIG, and plasma exchange all work in approximately 3-7 days
  3. Transfusion of platelets is ineffective and may worsen the condition even with antigen-negative platelets
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16
Q

How do you prevent Post Transfusion Purpura?

A
  1. Repeat reactions are rare and patients have been transfused with regular blood products including platelets at a later date without reaction
  2. Washed red cells and antigen-negative platelets should be ordered
  3. No problem with acellular products such as FFP or CRYO
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17
Q

When does Transfusion Associated Graft-vs-Host Disease (TAGVHD) occur?

A

May occur as soon as 4 days after a transfusion and up to a month afterwards

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18
Q

What is Transfusion Associated Graft-vs-Host Disease (TAGVHD)?

A

Produced when following successful engraftment of allogeneic T lymphocytes or their precursors, the foreign cells, if they are HLA incompatible, mount an attack against the host tissue

19
Q

What are signs and symptoms of Transfusion Associated Graft-vs-Host Disease (TAGVHD)?

A
  1. Fever
  2. Rash
  3. Elevated liver function tests
  4. Watery diarrhea
  5. Rapid progression to death due to marrow aplasia leading primarily to sepsis
  6. Virtually 100% mortality
20
Q

Who is at risk for Transfusion Associated Graft-vs-Host Disease (TAGVHD)?

A
  1. Patients with Immature Immunological Systems (fetus + newborns)
  2. Impaired Cell Mediated Immunity Patients, Congenital or Acquired (like Acute leukemia)
  3. Hematopoietic Stem Cell Transplantation or Bone Marrow Transplant
  4. Solid Tumor
21
Q

What are the risk factors for Transfusion Associated Graft-vs-Host Disease (TAGVHD)?

A
  1. blood donor is homozygous for one of the patient’s HLA haplotypes
  2. recipient does not recognize the donor T cells as foreign, yet the donor cells see the recipient’s tissues as foreign
22
Q

What are the products implicated for Transfusion Associated Graft-vs-Host Disease (TAGVHD)?

A
  1. Granulocytes
  2. Whole blood
  3. Packed red cells
  4. Washed red cells
  5. Frozen-deglycerolized red cells
  6. Platelets
23
Q

What tests are used to diagnose Transfusion Associated Graft-vs-Host Disease (TAGVHD)?

A
  1. Clinical presentation
  2. Laboratory data
  3. Histopathology
24
Q

What cells are present in the epidermis of a patient with Transfusion Associated Graft-vs-Host Disease (TAGVHD)?

A
  1. Exocytosis of some lymphocytes
  2. apoptotic keratinocytes w/ lymphocytes
  3. sparse lymphocytic infiltration in the dermis
  4. Basal vacuolar change
25
Q

What is a Septic Transfusion Reaction?

A

a result of transfusion of bacterially contaminated blood components

26
Q

What are more contaminated in gram POSITIVE Septic Transfusion Reactions, platelets or RBCs?

A

platelets

27
Q

What are more contaminated in gram NEGATIVE Septic Transfusion Reactions, platelets or RBCs? (more severe and fatal)

A

RBCs

28
Q

What are the clinical presentations of Septic Transfusion Reactions?

A
  1. Fever, especially if > 2°C or more rise in temperature
  2. Chills
  3. Rigors
  4. Shock
  5. Renal failure
  6. DIC
29
Q

How does the blood become contaminated in Septic Transfusion Reactions?

A
  1. Bacteria most often originating from the donor, either from venipuncture or from unsuspected bacteremia (e.g Yersinia enterocolitica), but may also come from donor unit processing
  2. Bacterial multiplication is more likely to occur in blood components stored at room temperature than in refrigerated components
  3. Autologous units are equally as likely to have bacterial contamination as are allogeneic units
30
Q

What is the most common Gram Positive organism that causes Septic Transfusion Reactions?

A

coagulase-negative Staphylococci

31
Q

What is the most common Gram Negative organism that causes Septic Transfusion Reactions?

A

Escherichia coli

32
Q

What are Gram Positive organisms that causes Septic Transfusion Reactions?*

A
  1. coagulase-negative Staphylococci (most common)
  2. Streptococcus
  3. Staphylococcus aureus
  4. Bacillus cereus
  5. Propionibacterium acnes
33
Q

What are Gram Negative organisms that causes Septic Transfusion Reactions?*

A
  1. Escherichia coli (most common)
  2. Klebsiella sp.
  3. Serratia sp.
  4. Enterobacter sp.
  5. Acinetobacter sp.
  6. Providencia rettgeri
  7. Yersinia enterocolitica
34
Q

What do you do when Septic transfusion reaction is suspected?

A
  1. Stop the transfusion
  2. Notify the Blood Bank
  3. Rule out Acute Hemolysis and TRALI
  4. Gram stain and culture the unit (not a segment from the unit)
  5. Culture the patient
  6. Do not transfuse until the Blood Bank completes acute immune hemolysis work-up
  7. Blood Bank is to contact blood supplier to recall and quarantine any components from that same collection
35
Q

How do you treat Septic Transfusion Reactions?

A
  1. Prompt initiation of antibiotic treatment; choice is guided by gram stain results
  2. Maintain airway
  3. Pressors for hypotension/shock
  4. Support for DIC
36
Q

How do you prevent Septic Transfusion Reactions?

A
  1. Questioning of prospective blood donors regarding present or recent illnesses or antibiotic use
  2. Scrupulous attention to choosing, cleaning, and disinfecting donor’s phlebotomy site
  3. Discarding the first aliquot of donor blood removed (“Diversion”) removes the skin core that may enter the collection from the needle
  4. Care in preparation of components (e.g. protecting components in waterbaths)
  5. Visual inspection of units of blood for color changes, hemolysis, clots; however, many contaminated units have no visual changes
  6. Do not infuse units for more than 4 hours
  7. Change blood filters and tubing as per manufacturer’s recommendations
  8. As of March 2004, all platelet units are tested for bacterial contamination; many blood collection centers were holding platelet units for 24 hours and then culturing aliquots from the units for another 24 hours
  9. Platelet shelf-life extended from 5 to 7 days
37
Q

What is “PASSPORT”?

A

Ongoing Post Approval Surveillance Study of Platelet Outcomes, Release Tested
(FDA 2004)

38
Q

What percentage of bacterially contaminated platelets may escape detection by culture at 24 hours?

A

50%

39
Q

What technique increases platelet shelf-life to 7 days?

A

Large volume, delayed sampling (LVDS)

40
Q

What is Large volume, delayed sampling (LVDS)?

A

sample taken no sooner than 48 hours after collection with a sampling volume of at least 16ml, into both aerobic and anaerobic culture media

41
Q

How long should platelet samples be incubated? (like apheresis (SDP) platelets and pooled random donor platelets (RDP))

A

12 hrs

42
Q

What is InteCept System?

A

inactivation of bacteria in platelets and plasma by synthetic psoralen and ultraviolet A light

43
Q

What causes Infectious Complications of Blood Transfusion?

A

HIV
HCV
HBV
HTLV I/II
WNV
Chagas’ Disease
Malaria
Babesia
Classic CJD & VCJD
HAV
Parvovirus
CMV
EBV
HHV 6 & 8
Syphilis
Others

44
Q

Summarize what to do when someone gets a transfusion reaction?

A
  1. Recognize, treat, and prevent adverse effects to transfusion
  2. Report suspected reactions to the Blood Bank and to the Blood Supplier
  3. The best way to avoid transfusion reactions is to transfuse only when indicated and to avoid unnecessary transfusions

BMS 185 Lecture (11 decks)

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