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Heme / Onc > SM_256b: Blood Transfusions - Compatibility / Complications > Flashcards

SM_256b: Blood Transfusions - Compatibility / Complications Flashcards

(53 cards)

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1
Q

Blood group is ____

A

Blood group is genetically defined blood cell surface proteins or carbohydrates to which people make antibodies

  • Each blood group has its own gene or set of related genes
  • 30 RBC blood groups are defined
  • Carbohydrate blood groups: genes make the transferase enzymes which connect sugars together
  • Protein blood groups: genes make the proteins
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2
Q

Describe RBC compatibility testing

A

RBC compatibility testing

  • ABO compatability: patient and donor ABO typings
  • Rh D compatability: patient and donor D typings
  • Screen antibodies to non-ABO blood group antigens: to see if patient alloimmunized to RBC antigens from prior transfusion or pregnancy
  • Crossmatch: crossmatch with selected RBC donor unit, determine if the RBC unit is compatible with patient
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3
Q

Describe manual ABO typing

A

Manual ABO typing

  • Anti-A and anti-B
  • AB: both antisera agglutinate
  • O: neither aggultinate
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4
Q

Describe ABO blood types and antigens

A

ABO blood types and antigens

  • O: no A or B
  • A: trisaccharide
  • B: trisaccharide
  • AB: both A and B trisaccharides

Antibodies: IgM and IgG anti-A and anti-B, A or B antigens not present on self, naturally occurring beginning in infancy

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5
Q

Describe Rh D

A

Rh D

  • D- people develop anti-D when exposed to D+ RBCs: most D- pople have no Rh D protein
  • Pregnancy: D+ fetal RBCs into D- mother -> maternal anti-D can cause severe hemolysis
  • Rh Ig (passive anti-D) prevents immune anti-D after small amounts of D+ RBCs
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6
Q

In a transfusion, give ___ RBCs to D- patients

A

In a transfusion, give D- RBCs to D- patients

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7
Q

Patients can develop ____ after RBC exposure

A

Patients can develop hemolytic RBC alloantibodies after RBC exposure

  • Pregnancy or transfusion
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8
Q

Describe RBC antibody screening

A

RBC antibody screening

  • Antibody detects non-ABO RBC antibodies
  • If screen is reactive, more reagent RBCs are used to identify antibodies
  • Hemolytic (usually IgG) antibodies in 1-2% of patients
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9
Q

Describe RBC crossmatching to verify compatability of selected unit

A

RBC crossmatching to verify compatability of selected unit

  • Serological: patient has past or current hemolytic RBC antibodies, select units negative for target antigen and test patient plasma vs donor RBCs
  • Electronic: if patient does not have past or current hemolytic antibodies, type patient twice to verify and computer verification of ABO/Rh compatability
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10
Q

Direct antibody test tests RBCs directly for ____ or ____

A

Direct antibody test tests RBCs directly for IgG or C3

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11
Q

On direct antiglobulin test, IgG presence appears as ___

A

On direct antiglobulin test, IgG presence appears as warm autoantibody or transfusion reaction to transfused RBCs

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12
Q

On direct antiglobulin test, C3 presence appears as ___

A

On direct antiglobulin test, C3 presence appears as cold agglutinin and some warm autoantibodies

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13
Q

Describe RBC compatability testing terms

A

RBC compatability testing terms

  • Type and screen: patient ABO/Rh and antibody screen
    • Negative antibody screen: emergency RBCs safe
    • Positive antibody screen: identify antibody
  • Type and cross: patient ABO/Rh and antibody screen, crossmatch desired number of RBCs
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14
Q

If RBCs are medically necessary before compatability testing is done, use ___

A

If RBCs are medically necessary before compatability testing is done, use Group O RBCs

  • Rh- if girl or woman of childbearing age
  • Risk: non-ABO alloantibodies
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15
Q

Describe what to do when you get a lab specimen and when delivering blood

A

Lab specimen and when delivering blood

  • Avoid blood or labeling mixups
  • Check patient identity using wristband in hospital
  • Label all specimens immediately after collection before leaving the patient: have pre-printed labels ready but not on tubes yet
  • Blood transfusion is a time-out procedure: check correct patient and unit, two people check patient and unit at bedside, electronic bedside verification
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16
Q

Describe symptoms of a transfusion reaction

A

Transfusion reaction symptoms

  • Fever, chills, rigors
  • Hypotension, hypertension
  • Rash, itching
  • Respiratory: dyspnea, wheezing, throat swelling

Stop transfusion, maintain IV line, notify blood bank, send lab testing

If dermal allergic reaction (rash, hives, itching) notify blood bank, give anti-histamines, and restart unit carefully

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17
Q

Common transfusion reactions are ____, ____, and ____

A

Common transfusion reactions are allergic, febrile, and transfusion-associated circulatory overload

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18
Q

Describe presentation of allergic transfusion reactions

A

Allergic transfusion reactions

  • Dermal: itching, hives, rash, facial swelling
  • Airway: wheezing dyspnea
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19
Q

Allergic transfusion reactions result from ___

A

Allergic transfusion reactions result from IgE antibodies to allergens in plasma

  • Especially plasma-rich components such as plasma and platelets
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20
Q

Allergic transfusion reactions are treated with ___

A

Allergic transfusion reactions are treated with antihistamines (also prophylactic pre-transfusion)

  • Severe: epi, corticosteroids
  • Usually donor-specific, not recurrent
  • If recurrent or severe: washed RBCs or plasma-reduced platelets
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21
Q

Febrile non-hemolytic transfusion reactions present with ____, ____, or ____

A

Febrile non-hemolytic transfusion reactions present with fevers, chills, or rigors

  • Usually donor-specific, not recurrent
  • If recurrent: leukoreduced RBCs and platelets
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22
Q

Febrile non-hemolytic transfusion reactions result from ____

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A

Febrile non-hemolytic transfusion reactions result from patient antibodies to donor WBCs in blood bag

  • Cytokines from donor WBCs generated during storage
  • Treat: antipyretics (acetaminophen)
23
Q

Transfusion-associated circulatory overload presents with ___, ___, ___, and ___

Study These Flashcards
A

Transfusion-associated circulatory overload presents with dyspnea, hypoxia, pulmonary edema, and cardiac injury

24
Q

Transfusion-associated circulatory overload results from ___

Study These Flashcards
A

Transfusion-associated circulatory overload results from RBC / plasma in tranfusion expanding the intravascular volume

  • Treat with diuresis
  • Prevent by assessing volume status pre-transfusion
25
Describe serious transfusion reactions
Serious transfusion reactions * Transfusion-associated circulatory overload * Acute hemolytic * Transfusion-related acute lung injury * Septic * Anaphylactic * Transfusion-associated graft-vs-host disease
26
Extravascular hemolysis is ____ and involves ____ and then \_\_\_\_
Extravascular hemolysis varies in speed and involves IgG antibody binding to RBC and then phagocytosis of RBC * IgG binds to Fc receptors on phagocytes (especially in spleen) * Antibody activates complement
27
Intravascular hemolysis is ___ and involves ___ and then \_\_\_
Intravascular hemolysis is rapid and involves IgM or IgG antibody binding to RBC and then complement activation (MAC complex included) * MAC forms a pore
28
Describe presentation of acute hemolytic reactions
Acute hemolytic reactions * Fevers / chills * Hypotension / shock * Dark urine / renal insufficiency * Bleeding and prolonged PT / PTT
29
Acute hemolytic reaction pathogenesis involves \_\_\_\_
Acute hemolytic reaction pathogenesis involves intravascular RBC lysis * Free RBC membranes with antibody activate inflammation * Damage renal tubules -\> acute tubular necrosis * Activate clotting cascade -\> DIC
30
Acute hemolytic reaction results from \_\_\_\_
Acute hemolytic reaction results from incorrect blood specimen (wrong patient / blood type) * Mistransfusion to wrong patient * Antibody to RBC unit undetected in screen / crossmatch
31
Acute hemolytic reaction tests involve \_\_\_\_, \_\_\_\_, and \_\_\_\_
Acute hemolytic reaction tests involve direct antiglobulin test, repeat compatability testing, and urinalysis for hemoglobinuria
32
Acute hemolytic reaction treatment involves \_\_\_\_
Acute hemolytic reaction treatment involves diuresis to protect vs acute tubular necrosis * Plasma / platelets if needed for bleeding / coagulopathy * Blood pressure support is needed
33
Transfusion-related acute lung injury presents with \_\_\_, \_\_\_, \_\_\_, and \_\_\_
Transfusion-related acute lung injury presents with dyspnea, hypoxia, often fever, and diffuse pulmonary edema ≤ 6 hours after transfusion
34
Transfusion-related acute lung injury results from \_\_\_\_
Transfusion-related acute lung injury results from donor plasma antibodies to patient WBCs * Activated WBCs damage pulmonary capillaries * Donors often multiparous women, pregnancy-induced antibodies
35
Describe treatment, testing, and preveention for transfusion-related acute lung injury
Treatment, testing, and preveention for transfusion-related acute lung injury * Treat: respiratory support * Test: involved donors tested for anti-HLA and anti-neutrophil antibodies * Prevent: make plasma from male donors, test parous women platelet donors for HLA antibodies, and defer transfusion-related acute lung injury donors
36
Septic reaction to transfusion presents with \_\_\_\_, \_\_\_\_, \_\_\_\_, \_\_\_\_, and \_\_\_\_
Septic reaction to transfusion presents with fevers, chills, rigor, hypotension, and shock
37
Septic reaction to transfusion presents results from \_\_\_
Septic reaction to transfusion presents results from bacteria in blood bag (especially platelets)
38
Describe testing, treatment, and prevention of septic reactions to transfusion
Septic reactions to transfusion * Test: Gram stain and culture residual blood bag contents * Treat: broad-spectrum antibiotics guided by testing * Prevent: donor health screening (antiseptic blood collection, bacterial testing / culture of all platelets)
39
Anaphylactic reaction to transfusion presents with \_\_\_\_, \_\_\_\_, \_\_\_\_, and \_\_\_\_
Anaphylactic reaction to transfusion presents with hypotension, shock, airway edema, and obstruction
40
Anaphylactic reaction to transfusion results from \_\_\_\_
Anaphylactic reaction to transfusion results from recipient IgE antibodies to plasma allergens * IgA deficient patient can present with anti-IgA antibodies
41
Describe testing, treatment, and prevention of anaphylactic reactions to transfusion
Anaphylactic reactions to transfusion * Test: IgA level, anti-IgA antibodies * Treat: antihistamines, epinephrine, corticosteroids * Prevent: wash RBCs and platelets for IgA deficient patients
42
Transfusion associated graft vs host disease presents with \_\_\_\_, \_\_\_\_, \_\_\_\_, \_\_\_\_, and \_\_\_\_
Transfusion associated graft vs host disease presents with rash, fever, diarrhea, hepatitis, and pancytopenia 3-30 days post-transfusion * Cellular immune reaction, donor lymphocytes vs organs
43
Transfusion associated graft vs host disease results from \_\_\_
Transfusion associated graft vs host disease results from lack of normal rejection of transfused RBCs * Severe immunosuppression * Closely HLA-matched donor such as blood relative
44
Describe testing, treatment, and prevention of transfusion associated graft vs host disease
Transfusion associated graft vs host disease * Test: chimerism studies of blood or tissues * Treat: immunosuppression of graft vs host disease reaction * Prevent: gamma irradiation to RBCs / platelets for susceptible patients
45
Transfusion associated graft vs host disease resuls because \_\_\_
Transfusion associated graft vs host disease resuls because donor WBCs see recipients' other antigens as foreign
46
Describe RBC alloimmunization
RBC alloimmunization * Transfusion or pregnancy exposure * Delayed hemolytic transfusion reaction * Destruction of transfused RBCs days after transfusion * Restimulation of RBC antibodies after prior immunization * RBC antibodies can disappear over time then are not detected in compatability testing * Kidd (Jk) blood group antibodies are the most common causes
47
Describe HLA alloimmunization
HLA alloimmunization * Anti-HLA antibodies, transfusion, pregnancy * Febrile transfusion reactions * Platelet refractoriness: HLA antigens on transfused platelets * Organ or stem cell transplant graft rejection * Give leukoreduced RBCs/platelets if recurrent febrile reactions, need for recurring platelet transfusions, or organ / stem cell transplant patients / candidates
48
Describe donor screening
Donor screening
49
Describe current risk infection estimates from transfusion
Current risk infection estimates from transfusion * HIV: 1 in 1.5 million units * Hepatitis C: 1 in 1.1 million units * Hepatitis B virus: 1 in 1.0 million **HBV is most common but all are rare**
50
\_\_\_\_, \_\_\_\_, \_\_\_\_, and ____ can also be transmitted during transfusion
Zika virus, cytomegalovirus, babesios, and Creutzfeldt-Jakob disease can also be transmitted during transfusion * Cytomegalovirus: mainly in WBCs * Babesiosis: RBC parasite
51
Describe pathogen reduction technologies for transfusions
Pathogen reduction technologies for transfusions * Solvent-detergent (pooled plasma): disrupts RBCs * Psoralen-UV light (plasma and platelet units): UV does not penetrate RBC units * Riboflavin-UV light (plasma and platelet units): nucleic acid damage * Methylene blue-visible light (plasma units): nucleic acid damage
52
Solvent-detergent ___ disrupt non-enveloped viruses such as Hepatitis A and parvovirus
Solvent-detergent does NOT disrupt non-enveloped viruses such as Hepatitis A and parvovirus
53
Psoralen binds to \_\_\_, while UV light induces \_\_\_, leading to inactivation of microbes
Psoralen binds to nucleic acid, while UV light induces crosslinking, leading to inactivation of microbes * Also prevents graft vs host disease by inactivating donor WBCs

Heme / Onc (41 decks)

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