[27] CHAPTER XI LESSON 2

Question 1

include any adverse signs or symptoms associated with a transfusion and may be acute or delayed.

Answer 1

TRANSFUSION REACTIONS

Question 2

may have immunologic or nonimmunologic causes. 1. Acute HTR are rare immunologic reactions that may be life-threatening and are usually caused by ABO incompatibilities. The associated hemolysis is intravascular. The most common signs of an acute hemolytic reaction are fever, chills, and hemoglobinuria. Dyspnea and hypotension leading to shock are seen in severe reactions. The most severe cases may result in DIC and renal failure. 2. Nonhemolytic febrile transfusion reactions are mild immunologic reactions that are caused by HLA class I antigens on transfused WBCs or platelets. They are the most common type of transfusion reaction (1 in every 200 transfusions). Fever and chills are the most common symptoms. The use of leukocyte filters when transfusing blood can help reduce the frequency of these reactions. 3. Allergic reactions are the second most common type of transfusion reactions. These acute immunologic reactions are typically associated with urticaria and are thought to occur in response to reactions between recipient antibodies and soluble proteins in the donor units. Antihistamines given before the transfusion can reduce the risk of an allergic reaction. Anaphylactic reactions are very severe allergic reactions. Although rare, they can be life-threatening. They are usually caused by antibodies to IgA.

Answer 2

Acute reactions

Question 3

are rare immunologic reactions that may be life-threatening and are usually caused by ABO incompatibilities.

Answer 3

1. Acute HTR

Question 4

The associated hemolysis is intravascular.

Answer 4

1. Acute HTR

Question 5

The most common signs of an acute hemolytic reaction are fever, chills, and hemoglobinuria.

Answer 5

1. Acute HTR

Question 6

Dyspnea and hypotension leading to shock are seen in severe reactions.

Answer 6

1. Acute HTR

Question 7

The most severe cases may result in DIC and renal failure.

Answer 7

1. Acute HTR

Question 8

are mild immunologic reactions that are caused by HLA class I antigens on transfused WBCs or platelets.

Answer 8

2. Nonhemolytic febrile transfusion reactions

Question 9

They are the most common type of transfusion reaction (1 in every 200 transfusions).

Answer 9

2. Nonhemolytic febrile transfusion reactions

Question 10

Fever and chills are the most common symptoms.

Answer 10

2. Nonhemolytic febrile transfusion reactions

Question 11

The use of leukocyte filters when transfusing blood can help reduce the frequency of these reactions.

Answer 11

2. Nonhemolytic febrile transfusion reactions

Question 12

are the second most common type of transfusion reactions.

Answer 12

3. Allergic reactions

Question 13

These acute immunologic reactions are typically associated with urticaria and are thought to occur in response to reactions between recipient antibodies and soluble proteins in the donor units.

Answer 13

3. Allergic reactions

Question 14

Antihistamines given before the transfusion can reduce the risk of an allergic reaction.

Answer 14

3. Allergic reactions

Question 15

Anaphylactic reactions are very severe allergic reactions. Although rare, they can be life-threatening.

Answer 15

3. Allergic reactions

Question 16

They are usually caused by antibodies to IgA.

Answer 16

3. Allergic reactions

Question 17

is a life-threatening transfusion reaction caused by HLA antibodies.

Answer 17

4. Transfusion-related acute lung injury (TRALI)

Question 18

Symptoms are the same as those seen in adult respiratory distress syndrome and include acute respiratory distress, hypoxemia, pulmonary edema, fever, and hypotension.

Answer 18

4. Transfusion-related acute lung injury (TRALI)

Question 19

a. Bacterial contamination of the blood product

Answer 19

5. Acute nonimmunologic reactions

Question 20

b. Circulatory overload caused by too rapid transfusion

Answer 20

5. Acute nonimmunologic reactions

Question 21

c. Blood that has been hemolyzed by improper storage or mechanical stress (e.g., heart-lung machine)

Answer 21

5. Acute nonimmunologic reactions

Question 22

are characterized by the accelerated destruction of transfused RBCs and are most commonly associated with a secondary (amnestic) response to an RBC antigen.

Answer 22

1. Delayed HTR

Question 23

Delayed reactions may not be recognized for days, weeks, or even months after a transfusion, until a rapid decline in the recipient’s hematocrit is noticed.

Answer 23

1. Delayed HTR

Question 24

Patients may experience fever and mild jaundice.v

Answer 24

1. Delayed HTR

Question 25

The associated hemolysis is generally extravascular.

Answer 25

1. Delayed HTR

Question 26

IgG antibodies to Rh, MNS, Kell, Kidd, and Duffy antigens are often implicated.

Answer 26

1. Delayed HTR

Question 27

may be either acute or chronic.

Answer 27

2. Transfusion-associated GVHD (TA-GVHD) reactions

Question 28

An extremely high mortality rate is associated with TAGVHD.

Answer 28

2. Transfusion-associated GVHD (TA-GVHD) reactions

Question 29

These reactions occur when immunologically competent lymphocytes are transfused into an immunoincompetent host.

Answer 29

2. Transfusion-associated GVHD (TA-GVHD) reactions

Question 30

Bone marrow transplantation recipients may also develop TA-GVHD, but these patients typically have a chronic, milder disease with a much lower mortality rate.

Answer 30

2. Transfusion-associated GVHD (TA-GVHD) reactions

Question 31

The transfusion of irradiated units can prevent TA-GVHD in immunocompromised patients.

Answer 31

2. Transfusion-associated GVHD (TA-GVHD) reactions

Question 32

is a rare transfusion reaction usually seen in older female patients who have been sensitized to platelet antigens, either by previous transfusion or pregnancy.

Answer 32

3. Post-transfusion purpura

Question 33

These reactions are characterized by mild-to-severe immune thrombocytopenia with clinical bleeding in severe cases.

Answer 33

3. Post-transfusion purpura

Question 34

4. Other nonimmunologic transfusion reactions include:

Answer 34

a. Citrate toxicity from anticoagulant b. Hypothermia from transfusing cold blood c. Hyperkalemia from the increased potassium levels in banked blood d. Transfusion-induced hemosiderosis (iron overload) in patients who have undergone chronic transfusion

Question 35

Investigating transfusion reactions requires strict adherence to the following steps: 1. All [?] must be checked for proper identification. Clerical error is the most common cause of HTR. 2. A [?] from the patient is centrifuged, and the serum or plasma is examined for icterus or hemolysis and compared against the pretransfusion sample. 3. A DAT is performed on a [?]. A DAT is performed on the pretransfusion specimen if the post-transfusion specimen has a positive DAT. An antigen-antibody incompatibility is assumed if the post-transfusion specimen DAT is positive, and the pretransfusion DAT is negative. 4. Other tests to further investigate the cause of the incompatibility may be performed

Answer 35

patient records and blood product containers post-transfusion sample post-transfusion EDTA specimen

Question 36

Other tests to further investigate the cause of the incompatibility may be performed, including:

Answer 36

a. ABO and Rh on the recipient’s pretransfusion and post-transfusion specimens and on the donor units b. Repeat compatibility testing with pretransfusion and post-transfusion specimens c. Serum bilirubin on samples drawn 5 to 7 hours after transfusion d. Gram’s stain on recipient’s plasma and culture of donor unit bag e. Haptoglobin on pretransfusion and post-transfusion specimens f. Urine hemoglobin g. Coagulation studies

Question 37

 The first and most important step in ensuring that transfused blood will not transmit a pathogenic virus is

Answer 37

careful selection of the donor.

Question 38

is usually spread by the fecal-oral route in communities where hygiene is compromised.

Answer 38

 HAV

Question 39

 On infection with [?], the first positive test is HBV NAT and the first serologic marker to appear is HBsAg, followed by HBeAg and IgM anti-HBc within the first few weeks of exposure.

Answer 39

HBV

Question 40

is an immune globulin prepared from persons with a high titer of anti-HBs and is used to provide passive immunity to health-care workers and others who are exposed to patients with HBV infection.

Answer 40

 HBIG

Question 41

 A combined vaccine for [?] is available to provide immunity.

Answer 41

HAV and HBV

Question 42

infection is common among drug addicts and can occur simultaneously with HBV infection; diagnosis depends on finding anti-HDV or HDV RNA in the serum.

Answer 42

 HDV

Question 43

 Of all infections, 60% to 70% are asymptomatic. With the implementation of NAT, the window period has been reduced to 10 to 30 days.

Answer 43

HCV

Question 44

is the leading cause of liver transplants in the United States.

Answer 44

 HCV

Question 45

is an emerging agent associated with transmission through transfusion and is the leading cause of hepatitis in the United Kingdom.

Answer 45

 HEV

Question 46

 Diagnosis of infection is dependent on the presence of antibodies to both envelope and core proteins; HIV-positive persons with fewer than 200 CD4+ T cells per microliter are considered to have AIDS in the absence of symptoms

Answer 46

HIV-1 and HIV-2

Question 47

 Transfusion-associated infection is a concern for seronegative allogeneic organ transplant recipients and fetuses.

Answer 47

CMV

Question 48

Reactivation of a latent infection can occur when an individual becomes severely immunocompromised.

Answer 48

CMV

Question 49

 The risk of infection for low-birth-weight neonates is not as great as it was in the past due to better transfusion techniques and management of their conditions.

Answer 49

CMV

Question 50

detects the presence of anti- HIV and determines with which viral proteins the antibodies react.

Answer 50

WB confirmation test

Question 51

 The window period can be shortened by using the polymerase chain reaction, which detects infection before tests for antigen or antibody are positive.

Answer 51

HIV

Question 52

is the most frequent cause of transfusion-transmitted infection.

Answer 52

 Bacterial contamination

Question 53

 Because [?] for parasitic infections is not currently available, many blood banks have added questions to their donor questionnaire that address topics associated with risk for parasitic infection.

Answer 53

routine screening

Question 54

are in use for plasma and platelet products and under development for red cell products.

Answer 54

 Pathogen inactivation methods

Question 55

These methods remove or reduce the residual risk of transfusion-associated disease due to the window period, virus variants, laboratory mistakes, and new, emerging diseases.

Answer 55

 Pathogen inactivation methods

Question 56

is a process mandated by the FDA that directs collection facilities to notify donors who test positive for viral markers, to notify prior recipients of the possibility of infection, and to quarantine or discard

Answer 56

 Look-back