Transfusion Reactions Flashcards Preview

Liz's Blood Bank Module 2 > Transfusion Reactions > Flashcards

Flashcards in Transfusion Reactions Deck (81):
1

Diverse group of unfavorable transfusion related events taht occur during or after transfusion of blood and blood components

Transfusion reactions

2

Which transfusion rxn occurs w/ the transfusion of incompatible RBCs (most common) or plasma products that is immune mediated and results in intravascular or extravascular hemolysis?

Hemolytic transfusion reactions

3

Which transfusion rxn occurs where the immune system is a common pathway but intravascular and extravascular hemolysis doesn't occur?

Nonhemolytic transfusion reaction

4

Immediate/acute transfusion rxn occurs when?

During or w/in 24 hours of transfusion

5

Delayed transfusion rxn occurs when?

Several days to weeks after transfusion

6

List the two hemolytic reactions

1. Acute intravascular (ABO Abs)
2. Delayed extravascular (IgG Abs)

7

List the 5 immediate nonhemolytic rxns

1. Febrile
2. Allergic/anaphylactic
3. TRALI
4. TACO
5. Bacterial

8

List the 5 delayed nonhemolytic rxns

1. Alloimmunization
2. Post transfusion purpura (PTP)
3. Transfusion-related GVHD
4. Iron overload
5. Disease transmission

9

Abs associated w/ IHTRs and DHTRs

IHTRs: intravascular → IgM (ABO)
DHTRs: extravascular → IgG (Rh, Kell, Kidd, Duffy, SsU)

10

What is the most common cause of preventable hemolytic transfusion reactions?

Clerical error

11

Bedside procedures in the event of a suspected transfusion reaction (8)

1. STOP TRANSFUSION
2. Clerical check
3. Call MD
4. Call BB
5. Draw EDTA
6. Send EDTA, donor bag, tubing paperwork, and order to BB
7. Send 1st UA if AHTR is suspected
8. Keep IV lines open

12

Describe steps to follow in a lab investigation of a suspected transfusion reaction

- Clerical check and attached solution
- Centrifuge post-transfusion sample to assess for visual hemoglobinemia (compre to pre-transfusion sample)
- DAT performed on post-transfusion EDTA sampel
- Additional workup based on results of the above 3 items AND clinical symptoms of patient
- Perform DAT
- If >2°C temp rise, send bag to micro for culture

13

Why will a DAT will be either positive or negative in an acute HTR?

Negative if there is not an Ab-Ag rexn and positive if there is!

14

What is the characteristic appearance of the DAT when an acute or delayed HTR has occurred?

Positive/hemolyzed

15

Explain why a IAT on a post-reaction serum sample may be negative following the infusion of Ag positive blood to an individual w/ corresponding Ab

?

16

Most common transfusion-associated disease

Hepatitis

17

If a patient should come down with Hepatitiis or HIV suspected to be due to blood transfusion, the hospital should follow a reporting process. Hospital > notifies Blood center > notifies donor > gets retested > and Blood center > notifies hospital of results > notifies other facilities that used products

"Look-back" process

18

What 2 tests are diagnostic for a transfusion reaction?

- DAT
- Visual hemoglobin

19

Abnormally rapid heart rate

Tachycardia

20

Shortness of breath (SOB)

Dyspnea

21

FNHTR

Febrile nonhemolytic transfusion reaction

22

TRALI

Transfusion related acute lung injury

23

TACO

Transfusion associated circulatory overload

24

PTP

Post-transfusion (thrombocytopenic) purpura

25

TA-GVHD

Transfusion-associated graft vs. host disease

26

A rash of round, red welts on the skin that itches intensely, sometimes w/ dangerous swelling, caused by an allergic reaction, typically to specific foods

Urticaria

27

Unpleasant sensation of the skin that provokes the urge to scratch. It's a characteristic feature of many skin diseases and an unusual sign of some systemic diseases

Pruritis

28

Superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilation of the blood capillaries

Erythema

29

An immune response generated in an individual or strain of one species by an alloantigen from a different individual or strain of the same species

Alloimmunization

30

Accumulation of iron in the liver and/or heart but also endocrine organs, in patients who recieve frequent blood transfusions (such as those w/ thalassemia, sickle cell disease, aplastic anemia or MDS)

Transfusion hemosiderosis

31

"White-out" caused by changes in permeability of the pulmonary capillary membrane as a result of either a direct or an indirect pathologic insult

Noncardiogenic pulmonary edema

32

Condition that occurs due to a rapid transfusion of a large volume of blood

Circulatory overload

33

Therapy for an allergic reaction

Antihistamines (Benadryl)

34

Therapy for febrile reaction

Acetaminophen

35

Therapy for anaphylactic reaction

Epinephrine

36

Therapy for febrile reaction w/ ↓ platelets

Acetaminophen

37

Therapy for bacterial contamination reaction

Broad spectrum antibiotics

38

Therapy for urticaria reaction

Antihistamines (Benadryl)

39

Therapy for iron overload

Desferrioxamine (iron-chelating agent)

40

Cause of immediate HTR

ABO Abs

41

Therapy for TACO

- Oxygen therapy
- Diuretics/digoxin
- Slow transfusion

42

Cause of delayed HTR

Anti-Jka

43

Cause of febrile reaction

HLA Abs present in patient's plasma

44

Cause of allergic reaction

Patient's reaction to transfused plasma proteins of donor

45

Cause fo anaphylactic reaction

Recipient lacks IgA and has anti-IgA Abs

46

Cause of TRALI

Donor or recipient has anti-HLA Abs and female plasma donors (multiple pregnancies, therefore multiple exposures to foreign HLA/neutrophil Ags)

47

Cause of TACO

Transfusion is too fast → volume overload

48

Cause of bacterial contamination

- Yersinia enterocolitica (most common), E. coli, and Pseudomonas spp. prefer to grow in RBCs
- GPCs (Staphylococcus and Streptococcus) like the warm environment provided by platelets

49

Cause of post-transfusion purpura (PTP)

Involves Ab to platelet Ag, usually HPA-1A (almost everyone positive for Ag) → anti-PL^A1

50

Cause of TA-GVHD

Donor T lymphocytes attack recipient

51

Cause of iron overload

Complication of long-term RBC transfusions → "transfusion hemosiderosis"

52

Alternate name for immediate HTR

Acute intravascular reaction

53

Alternate name for delayed HTR

Delayed extravascular reaction

54

Alternate name for febrile reaction

FNHTR

55

Alternate name for allergic reaction

Urticarial reaction

56

Alternate name for TRALI

Noncardiogenic pulmonary edema

57

Alternate name for TACO

Circulatory overload

58

Alternate name for iron overload

Transfusion hemosiderosis

59

Blood product for delayed HTR

Ag negative RBCs

60

Blood product for febrile reaction

Leukoreduced products

61

Blood product for allergic reaction

Washed or frozen RBCs

62

Blood product for anaphylactic reaction

Washed or deglyc'd RBCs or IgA deficient products

63

Blood product for TRALI

Plasma from male donors

64

Blood product for TA-GVHD

Irradiated products

65

Fever, bleeding, tachycardia, hypotension, low back pain, dyspnea, hemoglobinuria, feeling of "impending doom", death

Immediate hemolytic

66

Fever/chils, mild jaundice, anemia

Delayed hemolytic

67

↑ temperature > or equal to 1°C or 2°F, chills

Febrile (non-hemolytic)

68

Urticaria, pururitis, flushing

Allergic reaction

69

Severe dyspnea, tachycardia, hypotension

Anaphylactic

70

Dyspena, chills, fever, HYPOtensive, pulmonary edema, "white out"

TRALI

71

Dyspnea, cyanosis, pulmonary edema, HYPERtension

TACO

72

Rapid onset of high fever, sepsis (bacteremia w/ concomitant hypotension, DIC), violent rigors, dyspnea, shock, death

Bacterial contamination

73

Thrombocytopenia

Post-transfusion purpura (PTP)

74

Skin (rash and/or sloughing off of skin), GI (diarrhea), BM (pancytopenia), Hepatitis, dermatitis, enteritis

TA-GVHD

75

Accumulation of iron affects function of heart, liver, and endocrine glands

Iron overload

76

LAB: DAT+, hemoglobinemia, ↑ bili and LDH, ↓ haptoglobin, hemoglobinuria

Immediate hemolytic

77

LAB: DAT+, IAT+, spherocytes

Delayed hemolytic

78

Febrile (nonhemolytic), allergic, anaphylactic, TRALI, TACO, and TA-GVHD are ONLY DAT ____

Negative

79

LAB: product discolored, patient DAT negative, hemoglobinemia, hemoglobinuria, and culture product positive

Bacterial contamination

80

LAB: extremely low platelet count, DAT negative

PTP

81

LAB: DAT negative, diagnosed w/ ferritin levels

Iron overload