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Derm, infectious disease, topical drugs, RBC disorders > Transfusion Medicine > Flashcards

Transfusion Medicine Flashcards

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1
Q

tube testing

A

Immediate spin:
IgM antibodies and insignificant
37ºC phase
IAT phase:
Detects RBCs coated with IgG +/- complement
Antibodies reacting at IAT are more often significant

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2
Q

Blood Groups

A 
Clinically significant
Hemolytic transfusion reaction
Hemolytic disease of the newborn/ fetus
Most significant antibodies 
Require previous exposure  
IgG 
warm reactive (37˚C)
Most insignificant antibodies  
Naturally occurring
IgM 
Cold reactive (below 37˚C)
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3
Q

ABO Blood systems- Type I chains

A

Type 1 chains: glycoproteins and glycolipids free-floating in secretions and plasma

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4
Q

ABO Blood systems- Type II chains

A

Type 2 chains: glycolipid and glycoprotein antigens bound to the red cell membrane

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5
Q

ABO Blood systems- Se gene

A

Se gene modifies type 1 chains to produce H antigen (substance)

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6
Q

ABO Blood systems- H gene

A

H gene modifies type 2 chains to produce H antigen (substance)

H antigen is further modified to make
A antigen
B antigen

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7
Q

ABO Blood systems- O gene

A

O antigen has no further modification of H antigen

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8
Q

ABO blood systems

A

Most important blood group
Genotype determined by three codominant alleles on the long arm of chromosome 9
Antigens are also carried on platelets, endothelium, kidney, heart, lung, bowel and pancreas
ABO antigens are present on fetal RBC’s by 6 weeks of gestation and reach adult levels by age 4

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9
Q

Bombay (Oh)

A

Bombay (Oh)
Lack of H, A and B antigens
Due to lack of H and Se genes (hh, sese)

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10
Q

ABO blood system - antibodies

A 
Antibodies are clinically significant and naturally occurring
Activates complement
Immediate intravascular HTR
Appear at 4 months of age and reach adult levels at age 10
Antibodies may disappear with age
Three antibodies:
Anti-A
Anti-B
Anti-A,B
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11
Q

ABO blood system - antibodies; Group A blood

A

Group A blood: anti-B IgM antibodies that react strongly at body temperatures (37ºC)

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12
Q

ABO blood system - antibodies; Group B blood

A

Group B blood: anti-A IgM antibodies that react strongly at body temperatures

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13
Q

ABO blood system - antibodies; Group O blood

A

Group O blood:
anti-A and anti-B IgG antibodies that react best at body temperatures
anti-A,B IgG against A or B cells
Mild HDFN (most common)

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14
Q

ABO Blood System - Forward typing

A

Forward typing
Red cell grouping
Patient’s red cells agglutinated by test anti-A, anti-B antibodies

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15
Q

ABO Blood System - Reverse typing

A

Serum grouping

Patient’s serum or plasma agglutinated by test A1 and B RBC

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16
Q

Rh System

A

Second most important blood group

Two genes:
RHD (D/-)
RHCE (C/c, E/e)

Antibodies:
D makes most antibodies, then c and E
D is very immunogenic; 80% of D-neg make anti-D
HTR with extravascular hemolysis
Severe HDFN with anti-D and anti-c
Mild HDFN with anti-C, anti-D and anti-e
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17
Q

Rh System - Antibodies

A

Prototypical HDFN
Not first pregnancy unless mom was previously transfused
D-neg mom with D+ baby

Prevention: RhIG (commercially prepared anti-D)
D-neg females at 28 weeks gestation
D-neg females ≤72 hrs. of D+ baby’s birth
D-neg females with pregnancy complications or invasive procedure (amniocentesis, etc..)

Contraindications:
D-neg female who already has anti-D
D+ females
D-neg mom with D-neg baby

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18
Q

RhIG dosing

A

RhIG Dosage:
One full dose vial (300µg) per 30 ml of D+ whole blood

One full dose vial (300µg) per 15ml D+ RBCs
Determine percentage of fetal-maternal hemorrhage:
Fetal blood screen; qualitative
Kleihauer-Betke; quantitative but poorly reproducible
Flow cytometry; quantitative and more accurate

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19
Q

Rh system

A 
KB% x blood volume = baby blood in mom
Blood volume = 70 kg x 70ml/kg = 4900ml
(if no weight is given use 5000 ml)
0.02 x 4900 = 98ml D+ baby blood
98/30 =3.2
Give 4 units RhIG

RhIG rules
If number after decimal is <5, round up
If number after decimal is ≥5, round up twice

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20
Q

Lewis System

A

Similar biochemistry to ABO system
In secretors, Leb mostly formed
In non-secretors, mostly Lea formed
Insignificant, naturally occurring, cold-reacting IgM antibodies

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21
Q

MNS system

A

Anti-M and anti-N: Insignificant, naturally occurring, cold-reacting IgM
Anti-S, anti-s, anti-U: Significant, exposure requiring, warm-reacting IgG
Anti-M is rarely associated with severe HDFN

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22
Q

I system

A 
Antigens are built on 2 types of chains
Simple (i) chains found in neonates
Branched I chains found in adults
Insignificant, naturally occurring, cold-reacting IgM auto-antibody
Auto-anti-I: 
-Cold agglutinin disease 
-Mycoplasma pneumonia infections
Auto-anti-i:
-Infectious mononucleosis
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23
Q

P system

A

Similar biochemistry to ABO system
P antigen is the parvovirus B19 receptor
Pk antigen is receptor for various bacteria and toxins
Insignificant, naturally occurring, cold-reacting IgM
Auto-anti-P:
-Paroxysmal cold hemoglobinuria
-Biphasic IgG autoantibody (bind cold, hemolyzes warm

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24
Q

Kidd System

A

Significant, exposure requiring, warm-reacting IgG (with IgM component)
Can fix complement with IgM component
Severe acute HTR possible
Delayed HTR, anamnestic, intravascular and severe
Mild HDFN

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25
Kell System
K antigen low frequency; k antigen high frequency (99.8%) Anti-K Most common non-ABO antibody after anti-D Significant, exposure requiring, warm-reacting IgG1 Most due to transfusion, not pregnancy Anti-k Very uncommon due to high frequency antigen Severe acute or delayed, extravascular HTR Severe HDFN McLeod phenotype/ McLeod Syndrome All Kell antigens decreased Hemolytic anemias with acanthocytes, myopathy, ataxia, peripheral neuropathy, cardiomyopathy X-linked chronic granulomatous disease
26
Duffy
Anti-Fya more common and significant than anti-Fyb Significant, exposure requiring, warm-reacting IgG Severe HTR, delayed and extravascular Mild, but occasionally severe HDFN Fy(a-b-) most common phenotype in African-Americans Fy(a-b-) are resistant to Plasmodium vivax and P. knowlesi infection
27
Blood Donation Permanent Deferrals
``` High risk behavior for AIDS (IVDA, male-male sex, exposure) Receiving money for sex Serologic positivity for HIV, HBV, HCV, HTLV Viral hepatitis after 11th birthday Use of transfusion clotting concentrates History of babesiosis or Chagas disease Growth hormone from human source Insulin from bovine sources Dura mater graft Lymphoma or leukemia Medication teratogens: Tegison vCJD risk ```
28
Blood Donation 3 year deferrals
Recovered from malaria Immigrants from malaria endemic areas (5 years of living) Medication teratogens: Soriatane
29
Blood Donation 1 year deferrals
``` Needle stick or other contact with blood Sex with person with HIV or hepatitis Sex with IVDA Rape victims Incarcerated >72 hrs. Paying for sex Allogeneic blood transfusion Allogeneic transplant Living with person with active hepatitis Receiving HBIG Tattoos/piercings Travel to malaria endemic area Syphilis or gonorrhea Non-prophylactic rabies vaccines Travel to Iraq ```
30
Other Blood Donation Deferrals
``` Pregnant: 6 wks. postpartum Non-routine dental work: 72 hrs. Immunizations: 2 or 4 week deferrals Drugs: Accutaine, finasteride: 30 days Duasteride: 30 days Aspirin: 48 hrs. Plavix or Ticlid: 2 weeks ```
31
Blood Donation Donor Testing
``` 500 ml taken ABO/RH Antibody screen Anti-HTLV I/II West Nile Virus NAT Anti-Trypanosoma cruzi (Chagas) Serologic syphilis RPR/VDRL FTA-ABS Hepatitis B HBsAg Anti-HBc HBV NAT Hepatitis C Anti-HCV HCV NAT HIV Anti-HIV1/2 HIV-1 NAT ```
32
Preoperative autologous blood donation
Less screening than allogeneic AABB standard: not to be crossed over into regular inventory Infectious disease screening not required unless units shipped to another facility
33
Type and Screen
Type and screen Records check: Previous antibodies or compatibility problems ABO/Rh testing Antibody screen Group O phenotyped RBCs Antigens required by FDA: D, C, c, E, e, Fya, Fyb, Jka, Jkb, K, k, Lea, Leb, M, N, P1, S, s
34
Type and Cross Match
Major crossmatch: recipient’s serum with donor RBCs | Minor crossmatch: donor serum with recipient’s RBCs
35
Blood Components - RBCs
expected to raise HCT 3%, HGB 1% g/dL Can be measured 15 minutes after transfusion Can be transfused with NS, ABO compatible plasma and 5% albumin
36
Blood Components - Platelets
Expected to raise count 20,000-30,000 in 1 hour | Do not require crossmatch or ABO compatibility
37
Leukoreduction
Leukoreduction: reduce the number of WBCs in the blood product Filters (prestorage) at time of collection Filters (pretranfusion) at bedside
38
Washing Blood Components
Washing: remove 99% of plasma | IgA deficiency
39
Blood Components: Irradiation
Irradiation: deactivates T-lymphocytes Immunosuppression Intrauterine transfusions, neonatal transfusions Hematologic malignancies Granulocyte transfusion Receiving blood from first degree relative donor Receiving HLA-matched units
40
Acute Transfusion Reactions Presenting With Fevers
Acute Hemolytic Febrile Non-hemolytic Transfusion Related Sepsis TRALI
41
Acute Transfusion Reactions Presenting Without Fevers
Allergic Hypotensive Transfusion-associated dyspnea TACO
42
Delayed Transfusion Reactions Presenting With Fevers
Delayed Hemolytic | TA-GVHD
43
Delayed Transfusion Reactions Presenting Without Fevers
Delayed Serologic Post-transfusion Purpura Iron Overload
44
Acute Transfusion Reaction
Signs and symptoms present within 24 hours of a transfusion
45
Delayed Transfusion Reaction
Signs and symptoms present after 24 hours of a transfusion
46
Signs, Symptoms, and Etiology of Immune Transfusion Reactions
``` Abdominal, chest, flank or back pain Pain at infusion site Feeling of impending doom Hemoglobinemia Hemoglobinuria Renal failure/ Shock DIC ``` Type II (antibody-mediated IgG /IgM) hypersensitivity reaction
47
Signs, Symptoms, and Etiology of Non-Immune Transfusion Reactions
Asymptomatic hemoglobinuria Chemical or mechanical damage to blood product
48
Acute hemolytic transfusion reaction - Intravascular
Due to ABO incompatibility ABO antibodies fix complement and leads to rapid lysis Also seen with other antibodies (Kidd)
49
Acute hemolytic transfusion reaction - Extravascular
Usually (but not always) less severe due to lack of systemic complement and cytokine activation Seen with Rh, Kell, Duffy antibodies
50
Acute hemolytic transfusion reaction - Treatment
Hydration/diuresis | Exchange transfusion
51
Transfusion Reaction Work Up
1. STOP THE TRANSFUSION! 2. Clerical check a. Bedside paperwork/ bag check b. Blood bank paperwork/ computer check 3. Draw post-transfusion sample a. Visible hemoglobinemia b. Compare to pre-transfusion sample 4. DAT a. Demonstrate RBC coating with IgG &/or b. complement in vivo b. Positive DAT does not prove AHTR c. Negative DAT does not disprove AHTR 5. Repeat ABO/Rh testing
52
Febrile non-hemolytic transfusion reaction
Most frequently reported reaction Unexplained increase in temperature 1ºC Etiology: increased pyrogenic substances from WBCs -Pretransfusion: donor WBCs secrete cytokines in storage bag -During transfusion: Recipient antibodies attack donor WBCs or vice versa Treatment -Antipyretics -Demerol
53
Symptoms, Mechanism, Treatment and Prevention of Mild Allergic Reactions
``` Very common Localized hives Angioedema Mild respiratory symptoms Mild laryngeal edema ``` ``` Type I (IgE-mediated) hypersensitivity to transfused plasma proteins Mast cell secretion of histamine and other mediators of allergic reactions ``` Diphenhydramine IV or oral (prevention) Wash blood products May restart transfusion after hives clear
54
Symptoms, Mechanism, Treatment and Prevention of Moderate Allergic Reactions
``` Stridor Hoarseness Wheezing Chest tightness Dyspnea ``` ``` Type I (IgE-mediated) hypersensitivity to transfused plasma proteins Mast cell secretion of histamine and other mediators of allergic reactions ``` Diphenhydramine IV Epinephrine
55
Symptoms, Mechanism, Treatment and Prevention of Severe (anaphylactic) Allergic Reactions
``` Uncommon Anaphylaxis very early Hypotension Lower airway obstruction Abdominal distress Systemic crash Urticaria Puritis ``` IgA deficient recipient with IgE anti-IgA Haptoglobin deficiency Latex drugs or foods in donor can lead to severe reactions in recipients Washed blood products IgA deficient blood products Benadryl with corticosteroids Epinephrine
56
Delayed hemolytic transfusion reactions
Extravascular hemolysis at least 24 hours but less than 28 days after transfusion Etiology Anamnestic response -Antibody formed but fades over time -Anamnestic rapid production of IgG antibody -Typical for Kidd, Duffy and Kell antibodies Primary response -Antibody is quickly formed and attacks still c-irculating transfused red cells
57
Transfusion associated graft vs. host disease (TA-GVHD)
Attack on recipient cells by viable T-lymphocytes in transfused blood product Patients present with - Fever 7-10 days post-transfusion - Face/trunk rash that spreads to extremities - Mucositis, nausea/vomiting, watery diarrhea - Hepatitis - Pancytopenia Patients at risk: all those requiring irradiation Treatment: Irradiate blood products
58
Transfusion Associated Sepsis
Transfusion associated sepsis Acute non-immune transfusion reaction Due to bacteria in contaminated platelets and RBCs Staph, strep, Yersinia, bacillus, pseudomonas, E. coli
59
Hypotensive Transfusion Reaction
Similar to severe allergic reaction but no skin symptoms, no GI or respiratory issues >30mm Hg drop in systolic BP; diastolic ≤80mm Hg Occurs <10 after stop Associated with patients taking ACE inhibitors or receiving blood with negatively charged filters
60
Transfusion related acute lung injury (TRALI)
#1 cause of transfusion related fatality in US New acute lung injury ≤6 hrs. post transfusion Associated with platelets but also RBC/WB Two proposed methods Neutrophils produce toxic free radicals that damage endothelial cells Donor anti-HLA or anti-neutrophil antibodies bind to recipient antigens and damage endothelial cells Transfusion
61
Transfusion associated circulatory overload
Acute onset of congestive heart failure as a direct result of blood transfusion
62
Post Transfusion Purpura
Rare Marked thrombocytopenia and increased risk of bleeding 10 days following transfusion Due to antibody against a common platelet antigen Anti-HPA-1A PLA1 has a frequency of 98%

Derm, infectious disease, topical drugs, RBC disorders (8 decks)

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