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09 Hematology > Therapeutics in Hematology 2 > Flashcards

Therapeutics in Hematology 2 Flashcards

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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
manifestation of fnhtr
fever and chills during or until 2 hrs after transfusion
26
prevention of fnhtr
``` leukocyte reduction (reduced due to universal leukoreduction) premedication: acetaminophen ```
27
t/f leukoreduction is done in the philippines
false, fnhtr is not that high and cost prohibitive
28
ddx for fhtr
ahtr and transfusion related sepsis negative hemolysis workup in fnhtr
29
treatment in fnhtr
antipyretics (acetaminophen) | meperidine (demerol) for severe
30
#1 cause of transfusion related fatality in us
transfusion related acute lung injury
31
mechanism for trali
page 3
32
common donor source in trali
multiparous women
33
timing of trali
within 6 hours, common wihtin 2 hours
34
prevention of trali
- do not transfuse when not needed - implicated donors should be deferred - male plasma use - testing
35
treatment for trali
supportive care (o2 and intubation)
36
treatment for allergic reactions
diphenhydramine | can restart transfusion when hives clear
37
manifestation of moderate allergic transfusion reactions (anaphylactoid)
upper/lower airway obstruction | +/- cutaneous manifestations
38
manifestation of severe allergic transfusion reactions (anaphylactic)
``` lower airway obstruction skin findings (urticaria, angioedema, generalized pruritus) ```
39
mechanism or severe allergic rxn
iga deficient recipient who has formed anti-iga of ige class
40
timing for severe allergic rxn
very early
41
prevention of severe allergic rxn
test for iga deficiency
42
treatment for severe allergic rxn
stop transfusion | steroids or epinephrine
43
mechanism of dhtr
patient exposed to non-abo red cell antigen that is not present in their own rbcs
44
antibodies seen in dhtr
kidd, duffy, kell ab
45
timing of dhtr
>24h but <28 d
46
common setting for transfusion associated graft vs host disease
donor is first degree relative
47
mechanism for ta-gvhd
page 4
48
manifestation of ta-gvhd
``` fever 7-10 days post transfusion face/trunk rash mucositis nausea/vomiting watery diarrhea hepatitis pancytopenia and marrow aplasia ```
49
prevention of ta-gvhd
get other donor | radiation in blood products
50
common setting for transfusion related sepsis
rbc transfusions
51
timing for trs
within first few minutes of transfusion
52
manifestation of trs
rapid onset high fever | symptoms similar to hemolysis
53
organisms typical in blood products
rbc: g- rods, yersinia enterolitica platelets: g+ cocci, g- rods
54
mechanism for ptp
platelet specific antibodies against GPIIIa on surface of platelets
55
timing for ptp
7-10 d
56
prevention and treatment for ptp
avoid further platelet transfusions ivig plasmapheresis
57
mechanism for alloimmunization
occurs after transfusion of products with low frequency unrecognized antigens
58
t/f alloimmunization can cause refractoriness of transfusion
true
59
treatment for alloimmunization
limit transfusions rational blood use single donor apheresed platelets hla matched platelets
60
nonimmune reactions
transfusion associated circulatory overload hypothermia electrolyte toxiciity
61
mechanism of taco
congestion due to volume of transfusion (manifest in pts with renal and heart failure)
62
treatment for taco
diuretics | aliquot of blood units
63
mechanism of hypothermia
due to transfusion of refrigerated or frozen blood = cardiac dysrhythmia
64
treatment for hypothermia
warm water bath
65
mechanism of hypocalcemia
due to citrate in preservation of plasma and prbc | - edta (anticoagulant and preservative)
66
mechanism of hyperkalemia
leakage of potassium during storage
67
mechanism of iron overloasd
transfuse regularly (>14 units prbc/year; thalassemia or aplastic anemia)
68
t/f after the 5th unit of transfusion it's considered iron overload
false, 10th unit
69
treatment for iron overload
rational blood use | chelation therapy

09 Hematology (9 decks)

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