Tranfusion

Question 1

Indications erythropheresis (6)

Answer 1

• Severe babebiosis
• Severe malaria
• Polycythemia vera
• SCD: life or organ-threatening complication
• SCD: stroke prevention
• SCD: prevention of iron overload

Question 2

Indications leukapheresis (1)

Answer 2

Symptomatic hyperleucocytosis

Question 3

Indications plasmapheresis (10)

Answer 3

• ABO incompatible HSCT
• ABO incompatible organ transplant
• TTP
• Myasthenia gravis
• PANDAS, severe
• Sydenham chorea, severe
• Acute Guillain-Barre syndrome
• Chronic inflammatory demyelinating polyneuropathy
• Goodpasture disease
• ANCA-associated glomerulonephritis (Wegener)
• Other indications exist*

Question 4

Platelet refractoriness - differential diagnosis

Answer 4

Non-immune mechanisms: old platelet product, ABO-incompatibility, fever, sepsis, DIC, splenomegaly
Immune mechanisms: auto-Ab, alloimmunization

Question 5

Patients at risk for TA-GVHD (5)

Answer 5

• Premature neonates
• Congenital immunodeficiency syndromes
• Patients receiving chemotherapy and/or radiation for malignancy
• Patients receiving immunosuppressive drugs after solid organ transplantation
• Patients receiving direct donations (heterozygous for HLA antigens)

Question 6

Name clinically significant auto-Ab on erythrocytes, other than anti-AB and anti-D.

Answer 6

Anti-K
Anti-E
Anti-c, Anti-C
Anti-Fya
Anti-Jka, Anti-Jkb
Anti-S

Question 7

Tranfusion medecine: describe forward and reverse testing

Answer 7

Forward: determination of blood group using patient’s erythrocytes
Reverse: determination of blood group using patient’s serum
Both techniques are done and should correspond.

Question 8

Name 1 situation where forward and reverse determination of blood group may not correspond?

Answer 8

Infants less than 9 months of age re: do not make isohemagglutinins but may carry maternal ones

Question 9

Choice of RBC for patients with sickle cell anemia

Answer 9

Provide fully matched blood (D, C, E, c, e, K, Fya, Fyb, JKa, JKb)

Alternative: partially matched blood (D, C, E, K antigens)

Question 10

Choice of RBC for patients with thalassemia

Answer 10

Usually not phenotypically matched re: very low incidence of alloantibodies, no crisis associated with hemolysis

Question 11

Types of ABO incompatibility in HSCT

How are they managed?

Answer 11

MAJOR: recipient has Ab against donor RBCs; may lead to erythroid aplasia
RBCs removed from HSCT before infusion
MINOR: donor has Ab against recipient RBCs
Plasma is removed from HSCT before infusion

Question 12

3 reasons for false positive DAT (other than auto- and allo-antibodies)

Answer 12

• Overcentrifugation or contaminated reagents
• Insufficient washing of patient’s RBCs
• Prolonged delay between centrifugation and testing

Question 13

What causes febrile nonhemolytic reactions during transfusion?

Answer 13

Presence of cytokines and other pyrogens in the blood product, released by leucocytes and platelets (during storage, or during infusion)

Question 14

Differential diagnosis of fever, during a transfusion?

Answer 14

• Febrile non-hemolytic reaction
• Acute hemolysis
• TRALI
• Sepsis from a contaminated unit

Question 15

Delayed hemolytic reaction: typical clinical scenario

Answer 15

Anemia, hyperbilirubinemia 3-10 days after RBC transfusion

Question 16

Delayed hemolytic reaction: how to make the diagnosis?

Answer 16

1) (+)ve DAT

2) (+)ve allo-antibodies on patient’s RBC and/or serum

Question 17

TRALI: pathophysiology

Answer 17

Partly understood

Appears to be caused by alloantibodies in blood product reacting with patient’s HLA or neutrophil antigens

Question 18

TA-GVHD: diagnostic criteria

Answer 18

A clinical syndrome occurring from 2 days to 6 weeks after cessation of transfusion characterized by characteristic rash; diarrhea; fever; hepatomegaly; liver dysfunction (elevated liver enzymes); marrow aplasia; and pancytopenia
DEFINITIVE if confirmed by skin or liver Bx
PROBABLE in absence of biopsy

Question 19

Name 6 potential causes of platelet refractoriness

Answer 19

• Splenomegaly
• Fever
• Alloantibodies
• Autoantibodies
• DIC
• Product factors: low platelet volume, washed platelets, ABO mismatch, etc

Question 20

Adverse reactions associated with infusion of hematopoetic stem cells

Answer 20

AE following regular transfusion +
AE related to DMSO (dimethyl sulfoxide)
- nausea, vomiting, flushing, headaches
- anaphylactoid reactions
- embolic events

Question 21

What is the definition of massive transfusion?

Answer 21

• Transfusion of at least 50% of total blood volume in 3h
• Transfusion of at least 100% of total blood volume in 24h
• Transfusion support to replace ongoing bloos loss corresponding to 10% of total blood volume/min

Question 22

Name clinical and laboratory features often encountered with massive transfusion (5)

Answer 22

• Hypothermia
• DIC (in plasma and platelets not replaced)
• Hypocalcemia
• Hyperkaliemia or hypokaliemia (large amounts of citrate)
• Acid-base abnormalities

Question 23

Acute hemolytic reaction: what is the management?

Answer 23

• Stop the transfusion
• Clerical check
• Return product to blood bank
• Supportive management: hydration, aggressive diuresis (furosemide, mannitol)

Question 24

When does TACO and TRALI occur following a transfusion?

Answer 24

Up to 8 h following a transfusion

Question 25

List advantages associated with platelets by single-donor apheresis?

Answer 25

- Increased amount of thrombocytes - Exposure to only 1 donor - Leukoreduced by processing (rather than additional procedure)

Question 26

Granulocytes transfusion in ALL patients; what products to give?

Answer 26

ABO compatible, irradiated, CMV (-)ve granulocytes | Need to be given within 24h of collection