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09 Hematology > Therapeutics in Hematology 2 > Flashcards

Therapeutics in Hematology 2 Flashcards

1
Q

levels of the apheresis

A

bottom: rbcs
middle: platelets, wbc
top: plasma and coagulation factors

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2
Q

uses for apheresis

A

treatment in mg or gbs

  • plasma has the antibodies to cause mg or gbs
  • replace with normal plasma and reinfuse
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3
Q

indications of collections in apheresis

A

plateletpheresis (1 donation = 6-8 units)
plasmapheresis (igs)
leukapheresis (wbs, lymphocytes, granulocytes)
peripheral blood stem cells (hct)
erythrocytapheresis
neocytapheresis

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4
Q

indications for removal in apheresis

A

therapeutic plasma exchange (gbs, chronic demyelinating polyneuropathy, mg, thrombotic thrombocytopenic purpura)

therapeutic leukapheresis (leukemia, hyper-viscosity syndromes)

therapeutic thrombocytapheresis (essential thrombocythemia)

therapeutic red cell (polycythemia vera)

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5
Q

steps in blood testing

A
  1. verify patient identification
  2. collect and label patient sample
  3. abo and rh typing
  4. antibody screening
  5. compatibility testing/cross matching
  6. select compatible units for transfusion
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6
Q

forward vs reverse grouping

A

forward: use anti-a, anti-b, anti-d to detect a, b and rh(d) antigens on rbc
reverse: use type a and b rbc to detect anti-a and anti-b antibodies in recipient plasma

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7
Q

purpose of antibody screening

A

to check of there are low level antibodies which can lead to incompatible transfusion

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8
Q

steps in antibody screening

A

use type o to detect antibodies

detect antibodies = use panel type o to identify recipient antibodies then provide rbc units which lack antigens

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9
Q

types of compatibility testing

A

serological crossmatch: mix donor and recipient

electronic crossmatch: use computer algorithms (only for recipients with neg antibody screen and indep confirmed blood)

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10
Q

t/f if crossmatch-compatible blood products cant be found, incompatible units may be used at the physician’s discretion if transfusion outweighs the risk of incompatible blood

A

true

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11
Q

major crossmatch

A
  1. get plasma or serum from patient and add to donor cells
  2. incubate at 37 for 1 hr
  3. transfuse
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12
Q

results of major corssmatch

A

(+) agglutination = incompatible

(-) agglutination = compatible

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13
Q

risks of transfusion complication reactions

A

febrile nonhemolytic transfusion reactions
allergic
delayed hemolytic

most unlikely: anaphylactic

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14
Q

risk of transfusion infectios

A

most common hep b

hep c, hiv, htlv, least: malaria

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15
Q

other complications in transfusion

A

rbc allosensitization
hla allosensitization
gvhd

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16
Q

t/f you can predict allergic reactions

A

false

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17
Q

risk of hiv transmission is due to ___

A

screening

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18
Q

most common cause of ahtr

A

clerical error

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19
Q

mechanism of ahtr

A

incompatible donor of rbcs coated with recipient serum igm antibodies that fix complement leading to intravascular hemolysis

cytokines = fever and chills
dat = (+) igg and complement
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20
Q

timing of ahtr

A

first 15 mins

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21
Q

manifestation of ahtr

A

fever and chills
back or infusion site pain
hypotension/shock (dic)
hemoglobinuria (due to lysis)

peripheral blood smear shows schistocytes and spherocytes

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22
Q

management of ahtr

A

stop transfusion
hydration to maintain urine output >100 cc/hr
diuresis with mannitol
vasopressors

dic: fresh frozen plasma, platelets, cyroprecipitate

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23
Q

most frequently reported transfusion reaction

A

febrile nonhemolytic transfusion reactions

more common in platelet transfusions

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24
Q

mechanism for fnhtr

A

increased pyrogenic substances (tnf-a, il1b, il6)

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25
Q

manifestation of fnhtr

A

fever and chills during or until 2 hrs after transfusion

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26
Q

prevention of fnhtr

A 
leukocyte reduction (reduced due to universal leukoreduction)
premedication: acetaminophen
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27
Q

t/f leukoreduction is done in the philippines

A

false, fnhtr is not that high and cost prohibitive

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28
Q

ddx for fhtr

A

ahtr and transfusion related sepsis

negative hemolysis workup in fnhtr

29
Q

treatment in fnhtr

A

antipyretics (acetaminophen)

meperidine (demerol) for severe

30
Q

1 cause of transfusion related fatality in us

A

transfusion related acute lung injury

31
Q

mechanism for trali

A

page 3

32
Q

common donor source in trali

A

multiparous women

33
Q

timing of trali

A

within 6 hours, common wihtin 2 hours

34
Q

prevention of trali

A
  • do not transfuse when not needed
  • implicated donors should be deferred
  • male plasma use
  • testing
35
Q

treatment for trali

A

supportive care (o2 and intubation)

36
Q

treatment for allergic reactions

A

diphenhydramine

can restart transfusion when hives clear

37
Q

manifestation of moderate allergic transfusion reactions (anaphylactoid)

A

upper/lower airway obstruction

+/- cutaneous manifestations

38
Q

manifestation of severe allergic transfusion reactions (anaphylactic)

A 
lower airway obstruction
skin findings (urticaria, angioedema, generalized pruritus)
39
Q

mechanism or severe allergic rxn

A

iga deficient recipient who has formed anti-iga of ige class

40
Q

timing for severe allergic rxn

A

very early

41
Q

prevention of severe allergic rxn

A

test for iga deficiency

42
Q

treatment for severe allergic rxn

A

stop transfusion

steroids or epinephrine

43
Q

mechanism of dhtr

A

patient exposed to non-abo red cell antigen that is not present in their own rbcs

44
Q

antibodies seen in dhtr

A

kidd, duffy, kell ab

45
Q

timing of dhtr

A

> 24h but <28 d

46
Q

common setting for transfusion associated graft vs host disease

A

donor is first degree relative

47
Q

mechanism for ta-gvhd

A

page 4

48
Q

manifestation of ta-gvhd

A 
fever 7-10 days post transfusion
face/trunk rash
mucositis
nausea/vomiting
watery diarrhea
hepatitis
pancytopenia and marrow aplasia
49
Q

prevention of ta-gvhd

A

get other donor

radiation in blood products

50
Q

common setting for transfusion related sepsis

A

rbc transfusions

51
Q

timing for trs

A

within first few minutes of transfusion

52
Q

manifestation of trs

A

rapid onset high fever

symptoms similar to hemolysis

53
Q

organisms typical in blood products

A

rbc: g- rods, yersinia enterolitica
platelets: g+ cocci, g- rods

54
Q

mechanism for ptp

A

platelet specific antibodies against GPIIIa on surface of platelets

55
Q

timing for ptp

A

7-10 d

56
Q

prevention and treatment for ptp

A

avoid further platelet transfusions
ivig
plasmapheresis

57
Q

mechanism for alloimmunization

A

occurs after transfusion of products with low frequency unrecognized antigens

58
Q

t/f alloimmunization can cause refractoriness of transfusion

A

true

59
Q

treatment for alloimmunization

A

limit transfusions
rational blood use
single donor apheresed platelets
hla matched platelets

60
Q

nonimmune reactions

A

transfusion associated circulatory overload
hypothermia
electrolyte toxiciity

61
Q

mechanism of taco

A

congestion due to volume of transfusion (manifest in pts with renal and heart failure)

62
Q

treatment for taco

A

diuretics

aliquot of blood units

63
Q

mechanism of hypothermia

A

due to transfusion of refrigerated or frozen blood = cardiac dysrhythmia

64
Q

treatment for hypothermia

A

warm water bath

65
Q

mechanism of hypocalcemia

A

due to citrate in preservation of plasma and prbc

- edta (anticoagulant and preservative)

66
Q

mechanism of hyperkalemia

A

leakage of potassium during storage

67
Q

mechanism of iron overloasd

A

transfuse regularly (>14 units prbc/year; thalassemia or aplastic anemia)

68
Q

t/f after the 5th unit of transfusion it’s considered iron overload

A

false, 10th unit

69
Q

treatment for iron overload

A

rational blood use

chelation therapy

09 Hematology (9 decks)

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