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Flashcards in Transfusion risk and reactions Deck (35):
1

2 main blood infections from 70s and 80s

HIV and hepC

2

5 key points to informed consent

1. obtained by treating phys
2. mandatory except emergecy and no decision maker
3. benefit, risk, alt. discussed
4. documented
5. advise patient what was given after

3

what is most common risk

transfusion associated circ. overload

4

* 3 things patients worry about

HIV, hep B and C
- 1/millions

5

what are most common

fever and hives

6

what are most common cause of death

TACO - circ overload
2. TRALI - trans assoc. acute lung injury

7

4 Sx occuring during or shortly after

1. fever
2. uritcaria
3. dyspnea
4. hypotension

8

def. fever and DDx (4)

1degree rise and temp over 38
1. acute hemolytic transfusion rxn (AHTR)
2. bact.
3. febrile non-hemolytic trans. rxn
4. fever due to underlying illness

9

mech. and manifestation of AHTR

mech
- incompatibility of donor and recip.
manif
- fever, chills
- hemouria, pain, hypotension, N/V, DIC

10

MGMT of AHTR

- stop trans!
- check clerical errors
- notify blod bank
- send samples to recheck PT blood type
- send labs to look for hemolysis
- supportive care

11

potential causes of bact.

- normal skin flora
- bacteremia in donor
- contamination in handling
- most often platelets (room temp)

12

Sx of bact

- fever, chills
- hemouria, pain, hypotension, N/V, DIC

13

mgmt of bact

- stop trans
- notify bank and send back bloods
- culture Pt
- broad spectrum ABs

14

mech of febrile non-hemolytic trans. rxn

- cytokines in transfused products
- recipietn ABs in the transfused product

15

manif of febrile non-hemolytic trans. rxn

fever
- maybe worse
- diag. of exclusion

16

mgmt of febrile non-hemolytic trans. rxn

- pause transfusion
- give tylonol
- f resolves, can continue

17

DDx for urticaria (3)

1. anaphylaxis/major
2. minor allergic rxn
3. from another cause (food/drugs)

18

mech of anaphylaxis

- most unexplained
- possible recipient has IgG agains missing protein
- passive IgE from donor
- transfusion of allergen from donor

19

manif of anaphlaxis

- cutaneous almost always
- rash, hives, pruririts
- wheeze, stridor
- hypotension, chest pain, tachy

20

mgmt of anaphlaxis

- stop trans
- admin benadryl
- if ana, then epi, corticosteroids, pressors

21

mgmt of minor allergy

- bendryl (diphenhydramine)
- restart if hives

22

DDx of dyspnea (4)

1. TACO
2. TRALI
3. major allergy
4. not related to transfusion

23

mech of TACO

- volume overload
- too much to fast
- risk like CHF, eldeely, renal dys

24

manif of TACO

- orthopnea, cyanosis, HR BP JVP all UP
- volume overload on CXR

25

mgmt of TACO

-stop trans
- CXR
- supportive care

26

prevention of TACO

one unit at a time over 3.5 hours
- furosemide in PT > 60 or CHF

27

what is TRALI

tran. related acute lung injury
- non-cardiogenic pulm. edem
- w/in 6 hours
- new acute lung injury
- bilateral infiltrates on CXR
-

28

manif of TRALI

dyspnea, hypoxia, fever, hypotension

29

mgmt of TRALI

- stop
- inform transfusion med. lab
- CXR
- supportive care

30

what are sexes for TRALI prevention

male plasma
male or female buffy coat

31

def. hypotension

drop of 30 in syst. or distolic

32

DDx of hypotension (6)

TRALI
anaphlaxis
bact
AHTR
severe FNHTR
bradykinin mediated

33

mgmt of hypotension

- stop
- fluids
- rarely has sig. morbidity

34

4 delayed rxns

DHTR
PTP
TaGVHD
TTI

35

what is hemolytic transfusion rxn

due to formation of ABs to transfused RBCs that weren't originally found
- 3 days to 2 weeks
- need to ID and tell Pt so not given more

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