Transfusion risk and reactions

Question 1

2 main blood infections from 70s and 80s

Answer 1

HIV and hepC

Question 2

5 key points to informed consent

Answer 2

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

Question 3

what is most common risk

Answer 3

transfusion associated circ. overload

Question 4

• 3 things patients worry about

Answer 4

HIV, hep B and C

- 1/millions

Question 5

what are most common

Answer 5

fever and hives

Question 6

what are most common cause of death

Answer 6

TACO - circ overload

2. TRALI - trans assoc. acute lung injury

Question 7

4 Sx occuring during or shortly after

Answer 7

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

Question 8

def. fever and DDx (4)

Answer 8

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

Question 9

mech. and manifestation of AHTR

Answer 9

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

Question 10

MGMT of AHTR

Answer 10

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

Question 11

potential causes of bact.

Answer 11

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

Question 12

Sx of bact

Answer 12

• fever, chills

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

Question 13

mgmt of bact

Answer 13

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

Question 14

mech of febrile non-hemolytic trans. rxn

Answer 14

• cytokines in transfused products

- recipietn ABs in the transfused product

Question 15

manif of febrile non-hemolytic trans. rxn

Answer 15

fever

• maybe worse
• diag. of exclusion

Question 16

mgmt of febrile non-hemolytic trans. rxn

Answer 16

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

Question 17

DDx for urticaria (3)

Answer 17

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

Question 18

mech of anaphylaxis

Answer 18

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

Question 19

manif of anaphlaxis

Answer 19

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

Question 20

mgmt of anaphlaxis

Answer 20

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

Question 21

mgmt of minor allergy

Answer 21

• bendryl (diphenhydramine)

- restart if hives

Question 22

DDx of dyspnea (4)

Answer 22

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

Question 23

mech of TACO

Answer 23

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

Question 24

manif of TACO

Answer 24

• orthopnea, cyanosis, HR BP JVP all UP

- volume overload on CXR

Question 25

mgmt of TACO

Answer 25

- stop trans - CXR - supportive care

Question 26

prevention of TACO

Answer 26

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

Question 27

what is TRALI

Answer 27

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

Question 28

manif of TRALI

Answer 28

dyspnea, hypoxia, fever, hypotension

Question 29

mgmt of TRALI

Answer 29

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

Question 30

what are sexes for TRALI prevention

Answer 30

male plasma | male or female buffy coat

Question 31

def. hypotension

Answer 31

drop of 30 in syst. or distolic

Question 32

DDx of hypotension (6)

Answer 32

``` TRALI anaphlaxis bact AHTR severe FNHTR bradykinin mediated ```

Question 33

mgmt of hypotension

Answer 33

- stop - fluids - rarely has sig. morbidity

Question 34

4 delayed rxns

Answer 34

DHTR PTP TaGVHD TTI

Question 35

what is hemolytic transfusion rxn

Answer 35

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