Transfusion Medicine

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  1. What is the chance of receiving an ABO compatible unit of RBC's with no ABO testing?
  2. Who can donate plasma to an O blood type? A? B? AB?
    • O, A, B, AB
    • A, AB
    • B, AB
    • AB
  3. Rh positive and negative refers only to the ____ antigen.
  4. What is the most important cause of hemolytic disease of the newborn?
    Development of anti-D (80% of negative persons who receive Rh positive blood will develop anti-D
  5. In this type of pretransfusion testing, samples are good for 2-4 wks if the patient has not be transfused or pregnant within 3 months; otherwise samples are good for 3 days. RBC typing -- ABO, Rh (D); Antibody screening: alloantibodies, autoantibodies; a low titer IgG antibody may not be detectable
    Type & Screen
  6. In this type of pretransfusion testing, there is an estimated >50% need for transfusion. Nonexpired T & S samples can be used. The patient's serum is reacted with potential donor RBCs. In general, type specific donor units are tested. If patient has an alloantibody or a specific autoantibody, antigen negative donor units are tested. Compatible (or least-incompatible) units are reserved.
    Type & Crossmatch
  7. Transfusion criteria for erythrocytes are dependent on clinical situations. What are three indications for an erythrocyte transfusion?
    • Active Bleeding
    • Chronic Anemia
    • Hemoglobinopathies
  8. In what two settings is a Granulocyte Transfusion useful in?
    • Neutropenic Adult: infection for 24-48 hours; lack of response to appropriate antibiotics or other therapies; myeloid hypoplasia of the bone marrow; reasonable chance for BM recovery
    • Neutropenic Neonate with Sepsis
  9. In what transfusion type is cross-matching not routinely performed?
  10. What are the two indications for a Platelet Transfusion?
    • Bleeding (venous/oozing): thrombocytopenia; dysfunctional platelets
    • Prophylaxis
  11. What are the adverse effects of a Platelet transfusion?
    • Alloimmunization
    • Bacterial Contamination
    • Other transfusion reactions
  12. What are the 5 indications for a transfusion of Fresh Frozen Plasma?
    • Active Bleeding
    • Multiple Coagulation Factor Deficiencies uncorrected by vitamin K, with bleeding risk
    • TTP/HUS
    • Coagulation Factor Deficienies for which no concentrate exists
    • Congenital Immunodeficiency Syndromes
  13. What are the four indications for a Cryoprecipitate transfusion?
    • Afibrinogenemia/ Hypofibrinogenemia
    • Dysfibrinogenemia
    • Factor XIII Deficiency
    • "Fibrin Glue"
  14. What are the signs and symptoms of acute or immediate transfusion reactions (hemolytic transfusion reactions; anaphylactic rxns; allergic rxn; febrile nonhemolytic rxn; transfusion-related acute lung injury; bacterial contamination; volume overload)?
    • Fever
    • Chills
    • New-Onset Pain
    • BP Changes
    • Respiratory Distress
    • Skin Changes
    • Urine Color Changes
  15. What is the cause of an immediate hemolytic reaction? How can it be prevented?
    • Transfusion of incompatible RBC product (most commonly ABO incompatibility)
    • Hemolysis can be intra- or extravascular
    • Prevention: proper identification; proper BB techniques
  16. What is the cause of an anaphylactic reaction? What is the treatment for this?
    • Anti-IgA in previously sensitized IgA-deficient recipients binds to donor plasma IgA
    • Stop transfusion; Use epi, intubation, steroids, & pressor support as needed; for future transfusions, use products from IgA-deficient donors or wash products to remove the plasma
  17. What transfusion reaction are these symptoms associated with?
    Fever + chills; renal failure; flank pain; hypotension; hemoglobinuria; other pain; generalized bleeding; DIC; flushing; SOB; N&V; jaundice
    Can start within minutes of starting transfusion
    Lab Findings: anemia; hemoglobinemia; hemoglobinuria; indirect bilirubinemia; decreased haptoglobin; increased LDH
    Immediate Hemolytic Reaction
  18. What transfusion reaction are these signs and symptoms associated with?
    Range from uticaria & pruritis to fatal shock
    Include perilaryngeal edema, bronchospasm, dyspnea, coughing, periorbital edema, flushing, diarrhea, chest pain, abdominal cramping, hypotension, feeling of doom.
    No fever
    Starts within seconds of transfusion
    Anaphylactic Reaction
  19. What is the cause of an allergic reaction to a transfusion? How is this treated?
    • Reaction initiated by donor plasma proteins; mediated by histamine + leukotrienes
    • Treat with Benadryl (epi or steroids if severe)
  20. What transfusion reaction are these signs and symptoms associated with?
    Erythema, uticaria, pruritis, + fever
    Allergic Reaction
  21. What is the cause of a febrile reaction to a transfusion? How is this treated and prevented?
    • Donor WBC cytokines or recipient anti-WBC Ab's
    • Stop transfusion; antipyretics; leukocyte-reduced blood products in future
  22. What transfusion reaction are these signs and symptoms associated with?
    1 degree C rise without another medical explanation; + chills, hypotension, cyanosis, cough, dyspnea, tachypnea, tachycardia
    Febrile Reaction
  23. What is the cause of a Transfusion-related Acute Lung Injury (TRALI)? What is the treatment?
    • WBC antigen/antibody reaction; pulmonary capillary damage
    • Respiratory and hemodynamic support
  24. What transfusion reaction are these signs and symptoms associated with?
    Progressive respiratory distress with fever, chills, cough, cyanosis, hypoxemia, hypotension; CXR with bilateral diffuse pulmonary infiltrates
    Occurs within 6 hours of transfusion
    Transfusion-Related Acute Lung Injury (TRALI)
  25. What is the cause of a Bacterial Contamination in a transfusion? What is the appropriate treatment?
    • Skin flora, Pseudomonas, E. coli, Yersinia enterocolitica; most common with platelets
    • Stop transfusion; broad-spectrum antibiotics; hemodynamic & respiratory support
  26. What is the cause of a Transfusion-associated Circulatory Overload (TACO), or Volume Overload? What is the appropriate treatment?
    • Occurs in CHF patients if transfused too fast
    • Stop transfusion --> slow rate if product is still needed; diurese; hemodynamic & respiratory support
  27. What transfusion reaction are these signs and symptoms associated with?
    Fever with chills, skin flushing & dryness; hypotension; myalgia; abdominal pain; N&V; bloody diarrhea; renal failure; DIC
    Start within minutes to just after transfusion
    Bacterial Contamination
  28. What transfusion reaction are the following signs and symptoms associated with?
    Dyspnea, headache, orthopnea, coughing, cyanosis, restlessness, tachycardia, systolic hypertension
    Volume Overload or Transfusion-associated Circulatory Overload (TACO)
  29. What is the cause of a delayed hemolytic reaction? What is the appropriate treatment?
    • Primary (10-14 days) or secondary (3-7 days) antibody response to donor RBCs; extravascular hemolysis
    • Supportive care; steroids; RBC transfusions; identify Ab
  30. What transfusion reaction are the following signs and symptoms indicative of?
    Usually mild: fever + chills, jaundice, anemia
    Occassionally severe: renal failure, hypotension; DIC
    Delayed Hemolytic Reaction
  31. What is the cause of an Alloimmunization transfusion reaction? What is the appropriate treatment?
    • Immune response to a foreign antigen
    • Usually no treatment is necessary; future RBC transfusions require phenotype matching; future platelet transfusions may require crossmatching
  32. What transfusion reaction are the following signs and symptoms indicative of?
    Mild anemia; platelet refractories; bleeding
  33. What is the cause of Graft-Versus-Host Disease, and how can it be prevented and treated?
    • Cause: Donor T cells attach incompatible recipient cells; donor is usually immunocompromised (or 1st degree relative)
    • Prevention: Blood component gamma irradiation
    • Treatment: corticosteroids, cyclosporine, methotrexate, azathioprine, & antithymocyte globulin; 90-100% mortality
  34. What transfusion reaction are the following signs and symptoms indicative of?
    Hisotologic changes in skin, liver, GI tract, and BM; fever; watery diarrhea; erythematous skin rash progressing to desquamation; pancytopenia; elevated liver enzymes;
    Appear 3-30 days post-transfusion
    Graft-Versus-Host Disease
  35. What are the bacterial transmissable pathogens in a transfusion?
    • Y. enterocolitica
    • E. coli
    • Pseudomonas spp
  36. What are the transmissable viruses in a transfusion reaction?
    • HIV
    • HBV
    • HCV
    • HTLV
    • CMV
    • WNV
  37. What are the transmissible prions in a transfusion reaction?
    • CJD
    • nvCJV
  38. What are the transmissible Parasites in a transfusion reaction?
    • T. pallidum
    • Plasmodium spp
    • Babesia spp
    • T. cruzi
Card Set:
Transfusion Medicine
2011-05-07 18:10:27
Transfusion Medicine

Transfusion Medicine
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