Blood Bank 2: Summer 2024 > Transfusion Reactions > Flashcards

Transfusion Reactions Flashcards

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1
Q

How to do transfusion reaction workup

A

Perform ABO/Rh type and polyAHG adult DAT on both pre and post-transfusion samples
and get pee specimen

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2
Q

Why do pre-transfusion DAT?

A
  • To make sure post-transfusion DAT positive is due to transfusion
  • The patient could be attacking the donor RBCs after transfusion
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3
Q

Steps of treating transfusion reaction

A
  1. first identified by infusionist
  2. worked up by blood banker
  3. classified by pathologist
  4. treated by doctor
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4
Q

transfusion reaction classifications

A
  • hemolytic vs non-hemolytic
  • acute vs delayed (>24 hr after transfusion)
  • product vs patient
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5
Q

signs and symptoms of transfusion reaction

A
  • hemolysis
  • raise in temp
  • BP change
  • shortness of breath
  • pain
  • limited survival of transfused product
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6
Q

hemolysis signs

A
  • hemoglobinuria
  • hemoglobinemia
  • hgb level doesn’t rise
  • DAT pos
  • agglutination on slide
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7
Q

T/F
Plt ABO mismatch cannot cause HTR

A

False
It can bc some leftover plasma in the product may contain adverse antibodies

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8
Q

symptoms associated with raise in temp

A

fever
chills
nausea/vomiting

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9
Q

hypotension can lead to ____

A

shock

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10
Q

hypertension can lead to ____

A

jugular vein distension

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11
Q

shortness of breath associated with ___

A

wheezing
anaphylaxis
hypoxemia
angioedema

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12
Q

acute HTR clinical presentation

A
  • rapid onset
  • fever
  • pain
  • hypotension
  • hemoglobinemia/hemoglobinuria
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13
Q

acute HTR major complications

A
  • DIC
  • renal failure
  • shock
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14
Q

cause of acute HTR

A

complement activation

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15
Q

acute HTR essential lab tests

A
  • clerical/visual checks
  • ABO retype
  • tests for hemolysis: DAT, bilirubin, haptoglobin, urinalysis
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16
Q

managing acute HTR

A
  • treat DIC and shock
  • avoid clerical/technical error
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17
Q

delayed HTR clinical presentation

A
  • time-delay onset
  • fever
  • unexplained H/H drop
  • mild jaundice
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18
Q

major complications of delayed HTR

A

none

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19
Q

cause of delayed HTR

A

anamnestic

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20
Q

essential lab tests for delayed HTR

A
  • DAT
  • H/H
  • tests for hemolysis: bilirubin, haptoglobin, urinalysis
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21
Q

managing delayed HTR

A

provide antigen-negative results

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22
Q

severity factors for HTR

A
  • antigenicity
  • titer
  • ability to fix complement
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23
Q

which antibodies cause delayed HTR, DAT pos, and are extravascular

A
  • Kidd
  • Duffy
  • Kell
  • MNS
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24
Q

which antibodies cause acute HTR, DAT pos or neg, and are intravascular?

A
  • ABO
  • Rh
  • Kell
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25
febrile non-hemolytic transfusion reaction prevention (FNHTR)
leuko-reduced products
26
FNHTR symptoms
- fever/chills - nausea - tachycardia - hypertension
27
FNHTR causes
- WBC-derived cytokines in stored product or HLA antibodies in donor component plts
28
FNHTR lab findings and treatment
- negative DAT - no visible hemolysis - treat with acetaminophen (Tylenol)
29
allergic reaction prevention
use of a different donor's blood products
30
allergic reaction symptoms
- urticaria - itching - trouble breathing - hives - flushing - hypotension - anaphylaxis
31
allergic reaction causes
allergens and proteins in donor product (IgA antigens in plasma)
32
allergic reaction lab findings and treatment
- negative DAT - no visible hemolysis - treat with antihistamine (benadryl)
33
urticarial vs maculopapular rash
- urticarial: take benadryl and you'll be fine - maculopapular: BAD, means graft v host disease
34
prevention of graft v host disease
irradiation of cellular products to inactivate donor lymphocytes
35
symptoms of graft v host disease
- maculopapular rash - fever - diarrhea - multi-organ failure - 90% mortality rate
36
causes of graft v host disease
recipient does not recognize donor lymphocytes as foreign, but the **donor lymphocytes** attack the recipient's RBCs
37
graft v host disease lab findings
- pancytopenia - biopsy shows donor lymph infiltrates - may have bystander infections
38
graft v host disease treatment
- stem cell transplant - immunosuppressive treatment - treat symptoms
39
transfusion associated lung injury (TRALI) prevention
increase donor deferral for females who have been pregnant and males who have received transfusions
40
TRALI symptoms
- severe respiratory distress - **severe hypoxia/edema** - fever - hypotension
41
TRALI causes
- donor WBC anti-HLA antibodies reactive against recipient WBCS - recipient primed WBCs activated by biologically active substances in transfused blood products
42
TRALI lab findings
- recipient positive for HLA/HNA antigens - donor product positive for HLA/HNA Ab - chest x-ray has perfusions
43
TRALI treatment
- stop transfusion - supportive therapy w oxygen supplementation/mechanical ventilation
44
TACO prevention
- check lab values before transfusion - use small volume products for transfusion (split products) - transfuse slowly
45
TACO symptoms
- dyspnea - coughing - hypertension - tachycardia
46
TACO causes
- volume infusion that can't be processed by pt - high rates/volumes of infusion - underlying pathology e.g., CHF
47
TACO lab findings
- elevated BNP - no serological hemolysis
48
TACO treatment
- oxygen supplementation - diuresis
49
TRALI risk-factor
pt who received plasma from multiparous (pregnant multiple times) female
50
TACO risk factor
low circulation or heart output pt
51
graft v host disease risk factor
immunocompromised pt
52
prevention of sepsis
- focus on plt expiration dates, proper storage conditions, and bacterial testing of products - be aware plts pose highest sepsis risk even if irradiated bc stored at RT
53
sepsis symptoms
- body temp more than 2 degrees above normal - rigors (shaking chills) + hypotension
54
sepsis causes
- bacterially contaminated product transfused - plts: gpcs, gnb (enterics) - rbcs: gpcs, gnb (enterics) - plasma: water bath contaminants
55
sepsis lab findings
blood culture on patient matches product (find same organism in donor bag and pt)
56
sepsis treatment
ID contaminant and antibiotics
57
iron overload (hemosiderosis) prevention
transfusion of less than 20 cells in a year or transfusion of washed cells
58
hemosiderosis symptoms
- yellow-tinge to skin - multi-organ failure
59
hemosiderosis causes
accumulation of iron in tissues too many transfusions
60
hemosiderosis lab findings
extremely elevated ferritin
61
hemosiderosis treatment
- therapeutic phlebotomy - chelation therapy - exchange transfusion
62
citrate toxicity prevention
- ingestion of calcium before infusion - washed products
63
citrate toxicity symptoms
- paresthesias (tingling or prickling sensation) - hypotension - cardiac arrhythmia - tetany (involuntary muscle contractions) - coagulopathy
63
citrate toxicity causes
inability of liver to metabolize amount of anticoagulant infused
64
patients at risk for citrate toxicity
- liver disfunction/renal disease - neonates - hypothermic pt - plt and FFP recipients
65
citrate toxicity lab findings
- hypocalcemia - hypomagnesemia - prolonged PT
66
citrate toxicity treatment
calcium
67
post transfusion purpura prevention
plt crossmatch or HLA matched plt transfusion
68
post transfusion purpura symptoms
- profound thrombocytopenia - bleeding - petechiae
69
post transfusion purpura causes
patient has plt antibody, usually **anti-hpa1**
70
post transfusion purpura lab findings and treatment
- HLA lab workup to determine antibody ID - treat with IVIG or transfusion of diff product, pooled products might help
71
recognition of tranfusion reaction by nurse
- fever - chills - respiratory distress (coughing, wheezing, dyspnea) - hyper or hypotension - pain: abdominal or at infusion site - skin color/texture changes - jaundice - hemoglobinuria/emia - nausea/vomiting - unexpected bleeding - oliguria/anuria
72
clinical eval and management of transfusion reaction
- stop transfusion, continue w IV saline - document clerical recheck btwn patient and component - contact treating physician - monitor pt vitals - contact transfusion service
73
What to do if DAT is pos for IgG?
Elution
74
Goal of transfusion reaction workup
rule out hemolytic transfusion reaction
75
steps of transfusion workup testing (preanalytical, analytical, postanalytical)
**preanalytical**: clerical check and visual hemolysis check **analytical**: DAT and ABO re-type **postanalytical**: report findings to supervisor or transfusion service med director
76
further workup if hemolysis present
- elution - repeat screens on pre and post - chem tests (LDH, bilirubin, hemoglobin, haptoglobin)
77
further workup if sepsis sus
blood culture patient, donor unit, and saline attached to unit
78
further workup if lung injury sus
- contact blood manufacturer for follow-up testing on donor (HLA) - chest x ray
79
when to report to FDA?
- when donor product is at fault for causing transfusion reaction, even if it's just wrong donor selection - sepsis - TRALI - hemolytic
80
when is it **not** necessary to report TRN to FDA?
- delayed HTR - allergic reactions - febrile non hemolytic - circulatory overload
Blood Bank 2: Summer 2024
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