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Endocrine Exam 3 > 42 and 43 - Blood Products > Flashcards

42 and 43 - Blood Products Flashcards

1
Q

What is forward typing?

A

Forward typing tests for antigens on the patient’s cells

ANTIGENS

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2
Q

What is backward typing?

A

Backward typing tests for antibodies in the patient’s serum

ANTIBODIES

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3
Q

What is a Direct Coombs testing?

A
  • Tests for autoimmune hemolytic reactions
  • Remember, if RBCs have an Antigen, the serum usually does not have a corresponding antibody. But when it does, antibodies bind the RBC leading to destruction of the cell
  • Patient blood samples contain RBCs with antibodies attached to the cells
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4
Q

What else do we call a direct Coombs test?

A

AKA Direct Antiglobulin Test (DAT)

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5
Q

What does a direct Coombs test look for again?

A

Tests for antibody mediated hemolysis

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6
Q

Describe the process of Coombs testing

A
  • Antibodies are bound to red blood cells activate complement and result in cell lysis
  • Wash the patient’s RBCs and expose them to Coombs reagent
  • If antibodies are bound to the RBCs the Coombs reagent will bind those antibodies and lead to agglutination
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7
Q

What is the naturallly occurring anti-globulin do we test for in rheumatologic disease?

A

Rheumatoid factor

  • The Rh group alone has 50 different antigens
  • We only care about three (ABO, Rh-D, Bombay)
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8
Q

Describe ABO antigen

A

If you do not have an antigen, you are prone to forming antibodies against it

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9
Q

What are the ABO blood types?

A
  • A
  • B
  • AB
  • O
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10
Q

What are the genotypes for A?

A

AA
AO
OA

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11
Q

What are the genotypes for B?

A

BB
BO
OB

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12
Q

What are the genotypes for AB?

A

AB

BA

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13
Q

What are the genotypes for O?

A

OO

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14
Q

What are the antigens and antibodies for A?

A

Antigen A

Anti-B antibody

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15
Q

What are the antigens and antibodies for B?

A

Antigen B

Anti-A antibody

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16
Q

What are the antigens and antibodies for AB?

A

Both antigen A and B

Neither anti-A or anti-B

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17
Q

What are the antigens and antibodies for O?

A

Neither antigen A or B

Both anti-A and anti-B

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18
Q

How do you do ABO matching in a pinch?

A
  • Type O are universal donors of RBCs

- No A or B antigen on donor cells for recipient antibody to attack

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19
Q

What blood type are universal donors of plasma?

A
  • Type AB are universal donors of plasma

- No anti-A or anti-B antibody present to attack recipient RBC antigen

20
Q

What is the Bombay phenotype?

A
  • Type O blood is not truly “naked” of antigens
  • Most ABO blood displays H antigen
  • Hh blood typing
    Capital H indicates patient has the antigen
    Lower case h indicates patient lacks antigen
  • Type O blood of the Bombay Phenotype lacks H antigen (h/h genotype)
  • Type O blood without H antigen will have anti-H antibodies in the serum
  • Bombay phenotype patients have to receive blood from other Bombay phenotype patients
21
Q

What is the significance of RhD in terms of fetomaternal hemorrhage?

A

Significance of Fetomaternal Hemorrhage (FMH)

  • If mom is RhD antigen negative and she is exposed to RhD antigen positive blood, she may form anti-RhD antibodies
  • Maternal anti-RhD antibodies can cross the placenta and attack red blood cells of the fetus
  • This results in higher risk of fetal demise, newborn death, and newborn hemolysis
  • A patient with anti-RhD antibodies given RhD positive blood may have a delayed transfusion reaction
22
Q

Discuss the special processing of RBCs that have been donated - Leukocyte reduction

A

Leukocyte reduction

  • Performed by filtration
  • Vast majority of US blood supply is leukoreduced
  • Reduces risk of CMV transmission in Bone Marrow Transplant patients***
  • Does NOT prevent Transfusion Associated Graft Versus Host Disease
23
Q

Discuss the special processing of RBCs that have been donated - Washing

A

Washing

  • Washed in normal saline
  • Removes extra plasma and associated antibodies
  • Decreases risk of anaphylactoid reaction, particularly in IgA deficient patients***
  • IgA deficient patients have anti-IgA antibodies
24
Q

What is a “transfusion trigger” in terms of RBC transfusion in hemodynamically stable, surgical or ICU patient?

A
  • Hgb
25
Q

What is a “transfusion trigger” in terms of RBC transfusion in patients with active bleeding?

A

Hgb

26
Q

What is a “transfusion trigger” in terms of RBC transfusion in patients with active cardiovascular disease?

A

Hgb

27
Q

What is a “transfusion trigger” in terms of a GENERAL GOAL?

A

General goal in most patients is to keep hemoglobin 7.0-9.0

Some say 7.0-10.0

Pushing higher may increase mortality

28
Q

What are special cases that change the “transfusion trigger”?

A
  • Bleeding esophageal varices

- Sickle cell disease

29
Q

Describe why bleeding esophageal varices change the goal for Hb?

A
  • Keep the patient as close to Hgb 8.0 as possible
  • Less may impair oxygen delivery
  • More may lead to high intravascular pressure and worsen the bleed!
30
Q

Describe why sickle cell disease changes the goal for Hb?

A
  • Beyond the scope of this lecture!
  • They strongly suggest phoning your friendly hematologist for co-management!
  • Around 7-8
  • JUST KNOW CALL A HEMATOLOGIST ***
31
Q

What is “type and screen”?

A
  • Screens patient’s blood.
  • Does NOT prepare donor blood

When you order this, you will know what antigens the patient has, but you don’t have any blood ready

32
Q

What is “type and cross”?

A
  • Screens patient’s blood
  • Cross matches donor blood for patient use

When you order this, you will have the blood product ready

33
Q

What is pooled platelets?

A

Whole blood goes through a series of centrifuges to retrieve platelets along with a small amount of plasma.

Single donor platelets are obtained by apheresis
(More expensive, slightly lower transmission of infection)

34
Q

What are contraindications for platelet transfusion?

A
  • Heparin induced thrombocytopenia

- Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome

35
Q

Why don’t you want to give platelets to a patient with heparin induced thrombocytopenia?

A

Increased rate of thrombosis

You are already attacking your platelets via antibodies, this just increases the risk of

36
Q

Why don’t you want to give platelets to a patient with thrombotic thrombocytopenic purpura/Hemolytic uremic syndrome?

A

Accelerates the disease process

37
Q

What is one possibility when you give a transfusion?

A

INFECTION

** Transfusion-related infection **

38
Q

What type of infection is possible with a blood transfusion?

A
  • HIV
  • HCV
  • HBV
  • West Nile
  • CMV
  • Parasitic disease (malaria, chagas, babeiosis)
  • Bacterial infection (MOST common ** - 1 in 2-3,000) and most common in PLATELETS **

***KNOW platelet bacterial infection - test question??

39
Q

What are some adverse reactions that can occur when giving a transfusion?

A
  • Allergic reaction
  • Anaphylactoid/anaphylactic reaction
  • Febrile non-hemolytic transfusion reactions (febrile non-HTR)
  • Delayed hemolytic transfusion reaction (DHTR)
  • Acute hemolytic transfusion reaction (AHTR)
  • Transfusion associated circulatory overload (TACO) ***
  • Transfusion related acute lung injury (TRALI)
40
Q

Describe allergic reactions

A

Allergic reaction

  • Preformed antibodies to donor plasma proteins
  • Urticaria, pruritus, flushing, mild wheezing
  • Give antihistamines
  • Not typically dangerous, if symptoms resolve may complete transfusion
41
Q

Describe anaphylactoid/anaphylactic reactions

A

Anaphylactoid/Anaphylactic reaction

  • Antibody to donor plasma proteins
  • Hypotension, urticarial, bronchospasm, angioedema
  • Rule out hemolysis
  • Give epinephrine IM, antihistamines, and corticosteroids
  • Intubate if necessary
  • Minimize future transfusion risk with washed products
  • Check patient for IgA deficiency

KNOW IM ** –> Giving epinephrine IV is good at bringing up BP, but does NOTHING for the anaphylaxis… NEED IM **

42
Q

Describe febrile non-hemolytic transfusion reactions (febrile non-HTR)

A

Febrile non-hemolytic transfusion reactions (febrile non-HTR)

  • Due to preformed anti-WBC antibodies in the patient
  • Temperature rises >1 degree Celsius in first 1-2 hours of transfusion
  • Not typically dangerous. If no other symptoms you may resume transfusion
  • Give acetaminophen
  • Minimize recurrence by giving pre-transfusion acetaminophen
  • Minimize recurrence by using leukocyte reduced blood products
43
Q

Describe delayed hemolytic transfusion reaction (DHTR)

A

Delayed hemolytic transfusion reaction (DHTR)

  • Occurs 1-2 weeks after transfusion
  • Fever, jaundice, falling hgb
  • Repeat type and screen to look for new antibody formation
  • Repeat transfusion as needed with new type and screen
44
Q

Describe acute hemolytic transfusion reaction (AHTR)

A

Acute Hemolytic Transfusion Reaction (AHTR)

  • Preformed antibodies incompatible attack donor product antigen
  • Chills, fever, hypotension,back pain, DIC
  • Aggressively treat with IV fluids
  • Use pressors if needed (norepinephrine is usually preferred)
  • Keep urine output >1 ml/kg
  • Fatality rate: 1 in 1,800,000 units transfused
45
Q

Describe transfusion associated circulatory overload (TACO)

A

Hydrostatic fluid overload

  • Essentially decompensated congestive heart failure caused by transfusion
  • Dyspnea, tachypnea, jugular venous distention
  • New or worsening peripheral edema
  • Prevent with slow transfusion rates (1ml/kg/hr)
  • Treat with diuretics

The basic idea is that they have too much fluid, not too complicated, just give diuretics

46
Q

Describe transfusion related acute lung injury (TRALI)

A

Transfusion related acute lung injury (TRALI)

  • Massive capillary leak in the pulmonary vasculature (Both antibody and non-antibody mediated mechanisms)
  • Hypoxemia, transient leucopenia, bilateral pulmonary edema
  • Occurs within 6 hours of transfusion
  • Occurrence (1 in 5000 units PRBC, 1 in 2000 units Plasma, 1 in 432 units of whole blood)
  • 5-20% mortality depending on which source your review

This one gets a lot of press in the medical community - Just comes up looking like ARDS (acute respiratory distress syndrome)

Endocrine Exam 3 (13 decks)

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