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Transfusion Flashcards

1
Q

Organism - RBC antigen associations

A

Big I = Mycoplasma pneumonia
Little i = EBV
H and Lewis B = H. pylori
P = Parvovirus B19
Duffy = P. vivax

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2
Q

Life span of blood products
pRBCs
FFP
Platelets
Cryoprecipitate

A

pRBCs - 35 days with CPDA-1, 42 days with Additive Solution

FFP - 1 year at -18C, 7 yearss at -65C with FDA approval, 24 hours after thaw

Platelets - 5-7 days at RT

Cryo - 1 year frozen, 4 hours after thaw

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3
Q

Antibodies in hemolytic disease of newborn

A

anti-AB
anti-D
anti-K
anti-Fya
anti-C
anti-c
anti-S

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4
Q

Components of cryoprecipitate

A

Fibrinogen
vWF
Factor 8
Factor 13

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5
Q

Partial D vs weak D vs Rh null

A

Partial D - altered antigen, may type as D+ but need D- blood

Weak D - decreased levels, may type as D- on immediate spin but IAT D+, can receive D+ blood

Rh null - chronic hemolytic anemia

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6
Q

Blood type A2 typing

A

Forward type - A+

Reverse type - anti-A and anti-B (since make anti-A1 that react with commercial cells)

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7
Q

Acquired B typing

A

Forward type- strong A+, weak B+
(B antigen acquired from bacteria deacetylating A antigen)

Reverse type - anti-B

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8
Q

RhIG - one vial covers how much D+ blood?

A

One vial RhIG = 30 mL blood

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9
Q

RhIG - Kleihauer-Betke equation

A

-Get % fetal (microscopy)
-Assume 5L maternal blood
-Fetal volume = % fetal x maternal volume
- Divide fetal volume by 30 mL
If decimal .0 to .4 - add 1 vial
If decimal .5 to .9 - add 2 vials

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10
Q

Bombay vs Para-Bombay phenotype

A

Bombay: se/se h/h
No H antigens in blood or secretions

Para-Bombay: Se/se or Se/Se h/h
H antigens insecretions only

**Both need anti-H (Bombay) blood

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11
Q

Antigens enhanced by enzyme treatment

A

Enhanced - “A Rotten Kid LIP”
ABO
Rh
Kidd
Lewis
I
P

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12
Q

Antigens decreased by enzyme treatment

A

Decreased - “My Dog Lassie”
MNS
Duffy
Lutheran

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13
Q

Lewis A vs Lewis B genetics

A

Le gene makes Lewis A
Se gene makes H (H + LeA = LeB)

Le Le/le + Se Se/se = Lewis A+ Lewis B+ secretions and Lewis B+ RBCs

Le Le/le + se se = Lewis A+ LewisB- secretions and RBCs

le le + Se Se/se = Lewis A- Lewis B - secretions and RBCs (but still H+ secrtions)

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14
Q

Lewis antibodies - type, significance

A

anti-Lewis
IgM, clinically insignificant

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15
Q

I/i antibodies - significanc

A

anti-I/i
Clinically insignificant

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16
Q

Rh antigen nomenclature
R1
R2
R0
Rz

A

R = D+
R1 = DCe
R2 = DcE
R0 = Dce
Dz = DCE

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17
Q

Rh antigen nomenclature
r
r’
r’’
rgamma

A

r = D-
r = ce
r’ = Ce
r’’ = cE
rgamma = CE

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18
Q

MNS antibodies - exposure, type, significance

A

anti-M/N - natural, IgM, rare significance

anti-S - exposure, IgG, significant

19
Q

Kell antibodies - significance

A

anti-K and anti-k - both very significant

20
Q

McLeod Syndrome

A

McLeod syndrome
X-linked, absence of Kell antigens
Acantholytic hemolytic anemia and late onset neuromuscular

21
Q

Duffy antibodies - type, significance

A

anti-Duffy
IgG, significant

22
Q

Permanent donation deferrals

A

Dura mater graft
Bovine insulin, HGH or CJD
HBV, HCV, HIV, HTLV
Etretinate
Antiretroviral treatment

23
Q

3 year donation deferrals

A

History of malaria, residence in malaria country > 5 y

24
Q

1 year donation deferrals

A

Incarceration > 72 h
Sex with HBV

25
3 mo donation deferrals
Needle stick HIV risks (MSM, money) Hx transfusion Travel to malaria Syphilis or gonorrhea
26
Vaccine donation deferrals: No deferral 2 week referral 4 week deferral
Vaccine deferrals: - No deferral - toxoids, killed or recombinant vaccines - 2 week - live attenutated, measles, mumps, polio, typhoid, yellow fever - 4 week - Rubella, Chicklpox / shingles, unlicensed vaccines
27
Donation Physical Criteria Weight Temp Pulse BP Hgb/Hct
Donation Criteria: Weight - > 50 kg Temp - < 99.5 F Pulse - 50-100 bpm Bp - 90-180 / 50-100 Hgb/hct- Females 12.5/38%, Males 13.0/39%
28
Expected change in Hgb from 1u pRBCs
1 g/dL Hgb (3% Hct)
29
Apheresis platelets - adv vs disadv
Apheresis platelets Adv - fewer allergic rxns - less hemolysis from plasma - single donor so can HLA match Disadv - lower increment
30
Leukoreduction benefits
Leukoreduction: - Decreased febrile reactions - Decreased CMV transmission - Decreased HLA immunization
31
Irradiation benefits
Irradiation: - GVHD
32
RBC Washing Benefits
Washed RBCs (remove plasma and Igs): - Large volume to K sensitive patients, esp neonates when fresh units not avail - History of plasma-related reactions (eg IgA defic or anaphylactic rxns)
33
Indications for plasma transfusion
Plasma indications: Bleeding with multiple factor defic: - Liver disease - DIC - Dilutional coagulopathy Congenital factor defic with no concentrates - 5 and 11 Life threatening anti-coagulation reversal
34
RBC lifespan after irradiatio
Original date or 28 days after irradiation
35
Acute hemolytic reaction Sx Labs Tx
Acute hemolytic reaction - Sx: fever, pain. Severe: hypotension, dyspnea - Labs: positive DAT, indirect hyperbiliubinema, schistocytes or spherocytes - Tx: volume and BP support, maintain urine
36
Transfusion related sepsis Sx Dx Prevention
Transfusion related sepsis - Sx: fever > 38C with > 1 C increase, rigors, hypotension - Dx: Gram stain, culture matching patient - Prevention: clean skin, divert first 10-40 mL to container
37
Febrile non hemolytic reaction Sx Dx Timing Tx
FNHTR - Sx: shaking, increase RR, change in BP - Dx: >38C with > 1 C increase. - Timing: within 4 hours - Tx: stop transfusion, check no hemolysis
38
Allergic Transfusion Reaction Sx Timing Tx Prevention
Allergic Transfusion Reaction - Sx: urticaria - Timing: within 4 hours - Tx: pause transfusion, give antihstamine, resume once resolves - Prevention: wash products
39
TACO Sx Dx Tx Prevention
TACO - Sx: tachycardia, hypertension, dyspnea -Dx: Three of more of: - One of - A) acute or worsening resp compromise, B) Evidence of worsening pulmonary edema (clinical or radiographic) - CV changes (tachy, BP, EKG) - Fluid overload (resp to diuretics, weight) - Releveant biomarker (BNP) - Tx: stop tfn, O2. diuretics - Prevention: transfuse at risk patients slowly (2-4 mL/min or 1 mL/kg per hour)
40
Delayed hemolytic reaction Sx Labs
DHTR - Sx: often none but can be fever, anemia, jaundice - Labs: increased LDH, bilirubin, DAT+, newly positive screen, spherocytes
41
Transfusion associated GVHD Sx Prevention
Transfusion associated GVHD - Sx: erythroderma, vomiting, diarrhea, hepatitis, pancytiopenia - Prevention: irradiation at risk patients ( tfn from blood relatives or HLA compatible)
42
Indications for irradiation of products
Indications for irradiation: - Intrauterine transfusions - Prematurity, low birthweight - Congenital immunodef - Heme malignancy - Stem cell transplant - Crosmatched or family donation - Fludarabine therapy
43
Typical cold RBC antibodies
Le a Le b M N P

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