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Flashcards in Tranfusion Deck (26)
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1

Indications erythropheresis (6)

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

2

Indications leukapheresis (1)

Symptomatic hyperleucocytosis

3

Indications plasmapheresis (10)

- 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*

4

Platelet refractoriness - differential diagnosis

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

5

Patients at risk for TA-GVHD (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)

6

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

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

7

Tranfusion medecine: describe forward and reverse testing

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.

8

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

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

9

Choice of RBC for patients with sickle cell anemia

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

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

10

Choice of RBC for patients with thalassemia

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

11

Types of ABO incompatibility in HSCT
How are they managed?

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

12

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

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

13

What causes febrile nonhemolytic reactions during transfusion?

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

14

Differential diagnosis of fever, during a transfusion?

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

15

Delayed hemolytic reaction: typical clinical scenario

Anemia, hyperbilirubinemia 3-10 days after RBC transfusion

16

Delayed hemolytic reaction: how to make the diagnosis?

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

17

TRALI: pathophysiology

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

18

TA-GVHD: diagnostic criteria

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

19

Name 6 potential causes of platelet refractoriness

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

20

Adverse reactions associated with infusion of hematopoetic stem cells

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

21

What is the definition of massive transfusion?

- 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

22

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

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

23

Acute hemolytic reaction: what is the management?

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

24

When does TACO and TRALI occur following a transfusion?

Up to 8 h following a transfusion

25

List advantages associated with platelets by single-donor apheresis?

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

26

Granulocytes transfusion in ALL patients; what products to give?

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