300-314 Flashcards
What should be sent to the lab for a transfusion reaction investigation
A post-transfusion blood specimen, the blood bag, the administration set, and any attached IV soluutions.
What should be done at the first sign of a suspected transfusion reaction?
Transfusion should be stopped and the physician/blood bank should be notified
What is the preferred post-transfusion specimen for the DAT?
EDTA red cells to avoid reactionos due to complement
What is the most common type of transfusion reaction?/
Nonhemolytic febrile reaction
What is the definition of a febrile transfusion reaction
A rise in body temp of 1 degree celsius during or immediately after a transfusion, with no other explanation
Which patients have the most nonhemolytic febrile reactions
Multiply-transfused patients and multiparous women
How can nonhemolytic febrile reactions be prevented
By transfusion of leukoreduced RBCs
What is the 2nd most common type of transfusion reaction
Urticarial (hives)
Which transfusion reaction does not require that the transfusion be stopped or that a transfusion reaction investigation be performed
Urticarial
What course of action should be recommended when blood is ordered for a patient with history of previous allergic transfusion reactions?
An antihistamine may be administered half an hour before transfusion
What is the most frequent cause of fatal transfusion reactions
Hemolytic
What causes a hemolytic transfusion reaction
Immune destruction of donor cells by recipient antibody
Which antibody system is often implicated in immediate intravascular hemolytic transfusion reactions?
ABO
Group A RBCs are accidentally transfused to a Group O patient due to improper ID. What may happen?
A life-threatening hemolytic transfusion reaction. The naturally occuring anti-A in the recipient will destroy group A donor cells
Name a protein that is decreased in the blood of a patient following a hemolytic transfusion reaction.
Haptoglobin (binds free hemoglobin)
The cardiac ICU calls to report that a patient receiving blood is experiencing chillls, fever, difficulty breathing, and back pain. The urine in the catheter bag has a pink tinge. With which type of reaction are these signs of?
Intravascular hemolytic transfusion reaction
What lab findings would confirm that the patient had intravascular hemolytic transfusion reaction?
Hemoglobinemia and a positive DAT on post-transfusion specimen
What are the most serious consequences of hemolytic transfusion reactions?
Hypotension, shock, bleeding secondary to DIC, renal shutdown, and death
What is top priority in the management of a patient undergoing an acute hemolytic transfusion reaction?
Prevention of renal failure
A patient develops a fever during transfusion of RBCs. The transfusion is discontinued and lood bank is notified. A check of records show no misID or clerical errors. The post-trasfusion serum shows no hemolysis and the DAT is negative. What further testing is required?
None, the tests performed rule out a hemolytic transfusion reaction.
When is the best time to draw blood for a bilirubin in a transfusion reaction work-up?
5-7 hours after the tranfusion, it takes that long for sensitized RBCs to be removed from the circulation and destroyed by the RE system.
What special problems may be encountered in massive transfusion?
Dilutional thrombocytopenia, coagulopathy, citrate toxicity, hypothermia, potassium overload, acid-base imbalance, and reduced oxygen to tissues due to decreased 2,3 DPG.
Antibodies in which blood group system are most often associated with an anamnestic response?
Kidd
Who must evaluate all work performed as part of a transfusion reaction work-up?
Blood bank physician
