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MTAP > Adverse Effects of Blood Transfusion > Flashcards

Adverse Effects of Blood Transfusion Flashcards

1
Q

Most common adverse reactions

A

allergic transfusion reactions & febrile non-hemolytic transfusion reactions

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2
Q

Consistently the leading and most common transfusion reactions associated with mortality

A

TRALI & TACO

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3
Q

Most common cause of deaths associated with transfusion recipients

A

TRALI, TACO, TTBI

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4
Q

An essential transplant of foreign cells, always comes with risks

A

blood transfusion

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5
Q

What are the two critical components involves in the recognition and evaluation of suspected transfusion reaction?

A
  • clinical recognition by the person administering the transfusion (nurse/physician)
  • laboratory investigation of transfusion reaction (lab tech/med tech)
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6
Q

What is the first step once transfusion reaction is suspected?

A

IMMEDIATELY STOP TRANSFUSION

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7
Q

Majority of AHTRs is due to:

A

ABO incompatibility

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8
Q

Fatal transfusion reactions are mostly caused by:

A

clerical errors

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9
Q

What component is the most frequently involved with transfusion-associated sepsis?

A

platelets

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10
Q

Which blood product is easily contaminated?

A

platelets

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11
Q

Pain at the infusion site and hypotension are observed with what type of reaction?

A

AHTR

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12
Q

A suspected transfusion-related death must be reported to:

A

FDA

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13
Q

It is the development of non-ABO antibodies following transfusion, pregnancy, or transplantation.

A

Alloimmunization to RBC antigens

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14
Q

NHSN HEMOVIGILANCE

A combination of signs and symptoms associated with HEMOLYSIS, bichemical evidence of hemolysis, and serologic evidence of RBC incompatibility occurring during or within 24 hours after transfusion.

A

AHTR

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15
Q

An accelerated destruction of transfused RBC due to antibody-mediated incompability

A

AHTR

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16
Q

The severity of this transfusion reaction is related to the amount of incompatible blood transfused.

A

AHTR

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17
Q

Fever is its most common cause which often occurs with chills and rigors. Also, another frequent symptom is pain at the infusion site.

A

AHTR

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18
Q

A positive DAT 24 hours to 28 days after transfusion with either a positive eluate or a newly identified alloantibody in the plasma or serum and an evidence of hemolysis

A

DHTR

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19
Q

Most of its cases appear 7 to 10 days post-transfusion with either positive eluate or a newly identified alloantibody in the plasma and serum with an evidence of hemolysis.

A

DHTR

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20
Q

It has the same serologic findings as DHTR, but without hemolysis.

A

DSTR

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21
Q

List evidences of hemolysis.

A
  1. inadequate rise in hemoglobin
  2. rapid drop in hemoglobin to the pretrasfusion level
  3. appearance of spherocytes
  4. biochemical evidence of hemolysis
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22
Q

Early manifestation of AHTR can be confused with:

A

FNHTR

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23
Q

It is the ONLY presenting sign that often accompany DHTR

A

unexplained decrease in hemoglobin

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24
Q

A transfusion reaction associated with fever, macupapular rash, watery diarrhea, abnormal liver function, and pancytopenia.

A

TA-GVHD

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25
Q

Lists key reasons for non-immune hemolytic transfusion reactions

A
  1. improper shipping or storage temp
  2. incomplete deglycerolization
  3. inaappropriate needle bore size
  4. improper use of blood warmers
  5. unapproved fluid infusion
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26
Q

A rare event associated with acute respiratory distress

A

TRALI

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27
Q

It is the leading cause of mortality due to adverse reactions to transfusion

A

TRALI

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28
Q

NHSN HEMOVIGILANCE

What are the NHSN hemovigilance definitions of TRALI?

A
  1. Absence of ALI
  2. ALI during or within 6 hrs after transfusion
  3. Evidence of HYPOXEMIA by blood gas or oxygen saturation testing
  4. Radiographic evidence of bilateral pulmonary edema
  5. Exclusion of circulatory overload and other causes of pulmonary edema
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29
Q

TRUE OR FALSE

Plasma from multiparous female donors may carry a greater risk of TRALI

A

TRUE

a strong association with previously pregnant female donors

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30
Q

It has been attributed to the presence of antbibodies in the plasma of the transfused unit that are directed against HLA or granulocytes antigens present on recepients leukocytes.

A

TRALI

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31
Q

What should you give to your patient if you wanted to prevent TRALI?

A

leukoreduced red blood cells

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32
Q

Designated when the given criteria for TRALI are present but another cause of ALI is also identified.

A

possible TRALI

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33
Q

When the criteria for TRALI is present but onset is 6-72 hours

A

delayed TRALI

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34
Q

Presence of three or more features of fluid overload occurring within 6 hrs after transfusion.

A

TACO

35
Q

An acute respiratory distress from pulmonary edema due to:
* excessive transfused fluid
* too rapid infusion rate
* inability to accomodate volume of transfused products

A

TACO

36
Q

Due to rapid or excessive administration of blood wihtout compensatory mechanisms involved, usually iatrogenic.

A

TACO

37
Q

Risk groups for TACO

A
  1. children
  2. elderly
  3. cardiac patients
  4. chronically-anemic patients
38
Q

Management for TACO

A
  1. therapeutic phlebotomy
  2. IV diuretics
  3. O2 therapy
39
Q

What are the defining features of TACO?

A
  • Acute respiratory distress
  • Elevated BNP
  • Elevated central nervous pressure
  • Evidence of left heart failure
  • Evidence of positive fluid balance
  • Radiographic evidence of pulmonary edema
40
Q

List AABB requirements for laboratory investigation of a transfusion reaction.

A
  1. Clerical check of the component bag, label, paperwork, and pretransfusion patient specimen.
  2. Repeat ABO testing on the post-transfusion sample.
  3. Visual check of the pre- and post-transfusion specimens for hemolysis.
  4. Direct antiglobulin test (DAT) on the post-transfusion specimen.
  5. Quarantine additional components prepared from the same donor collection.
  6. Report findings to transfusion service supervisor or medical director.
41
Q

A transfusion reaction that happens when patient is not capable of accomodating the volume of the transfused product

A

TACO

42
Q

Dyspnea occurs within 24 hrs after transfusion and all other diagnoses are excluded

A

TAD

43
Q

NHSN

  • adults - drop in systolic BP of ≥30 mmHg and systolic BP ≤80 mmHg
  • children - 25% drop in the baseline systolic BP
A

Hypotensive Transfusion Reaction

44
Q

nonspecific sign, seen alone during or within 1 hr after transfusion is finished

A

hypotensive transfusion reaction

45
Q

The collection of information on the complications of transfusion, analysis of these data, and subsequent data-driven improvements in transfusion practices.

A

Hemovigilance

46
Q

manifests as an increase in the body temperature of a recepient of 1C or more that is associated with transfusion

usually caused by anti-leukocyte antibodies against donor unit

A

FNHTR

47
Q

How should you prevent FNHTR?

A

use leukoreduced or leukopoor red blood cells

48
Q

what is used as treatment for FNHTR?

A

antipyretics

49
Q

fever greather than 100.4F (38C) or a change of at least 1.8F (1.0C) from the pretransfusion level occurring during or within 4 hrs after end of the transfusion or chills and/or rigors are present

A

FNHTR

50
Q

Prevention of ATRs

A
  • administration of anti-histamine
  • washed red blood products
51
Q

Differential Diagnosis of ATRs

A
  • If respiratory symptoms are prominent, include TRALI and TACO
  • If hypotension and/or shock are present, consider AHTRs and TTBIs
52
Q

Most common reaction seen with platelet and plasma transfusion.

It is second to FNHTR in RBC transfusion.

A

ATR

53
Q

Mild to moderate allergic reactions, transient and self-limited; headache, fever, chills, nausea, vomiting, abdominal pain, diarrhea, facial flushing, urticaria, itching, muscular cramps, and back pain are other common symptoms

A

Adverse Reactions to Infusion of Plasma-Derived Products

54
Q

Examples of Plasma-Derived Products

A
  • Albumin
  • Intravenous immune globulin (IVIG)
  • Human-derived factor concentrates
55
Q

Headache is the most commonly reported symptom

A

Adverse Reactions to Infusion of Plasma-Derived Products

56
Q

The appearance of signs and symptoms during or within 2 hours after the end of transfusion and the exclusion of other possible drug, environmental, and dietary causes

A

ATR

57
Q

generally mild to moderate reactions and refer to signs and symptoms limited to the skin and gastrointestinal tract.

A

ATR

58
Q

The most common manifestations are mucocutaneous reactions, including urticaria, pruritus, and localized or generalized rash. The NHSN Hemovigilance definition includes only anaphylactoid and anaphylactic signs and symptoms.

A

ATR

59
Q

A clinical syndrome developing from 2 days to 6 weeks after transfusion characterized by the typical skin rash seen, diarrhea, fever, enlarged liver, elevated liver enzymes, marrow aplasia, and/or pancytopenia

A

TA-GVHD

60
Q

Definite diagnosis is made by skin or occasionally liver biopsy showing characteristic histological features

A

TA-GVHD

61
Q

HIGH MORTALITY RATE

A

TA-GVHD

62
Q

A severe and sudden drop in the platelet count, usually occurring 5 to 10 days after transfusion due to alloimmunization to platelet-specific antibodies from prior transfusion or pregnancy

A

PTP

63
Q

1st symptom appears average of 11 days

definite dx: skin/liver biopsies

A

TA-GVHD

64
Q

Prevents TA-GVHD

A

irradiated blood

65
Q

Thrombocytopenia - less than 20% of the pretransfusion count and demonstration of alloantibodies against platelet specific antigens are required for diagnosis

A

PTP

66
Q

1st line of treatment of PTP

A

IVIG

px respond w/in hrs

67
Q

PTP patient won’t respond with IVIG

A

plasma exchange with FFP

68
Q

Patients have become alloimmunized to HLA (human leukocyte antigen) or platelet-specific antigens

A

Refractoriness to Platelet Transfusion and Alloimmunization

69
Q

The chief metabolic effects of transfusion involves citrate toxicity and
hyperkalemia

A

Adverse Metabolic Effects of Transfusion

70
Q

True or False

Hypocalcemia is an effect of citrate toxicity

A

True

71
Q

During RBC storage, intracellular potassium will slowly leak from the aging RBCs and this may cause increased potassium in the supernatant, leading to

A

hyperkalemia

72
Q

Hyperkalemia is very uncommon in massive transfusion in adults, but it is of special concern in

A

neonatal transfusions

especially in premature infants

73
Q

Citrate Toxicity: Hypocalcemia or Potassium Toxicity: Hyperkalemia

● Tingling of lips or fingertips
● Twitching or tremors
● Shivering
● Muscle contractions (carpopedal
spasms involving hands or feet)
● EKG abnormalities: prolonged
QT interval

A

Citrate Toxicity: Hypocalcemia

74
Q

Citrate Toxicity: Hypocalcemia or Potassium Toxicity: Hyperkalemia

● Muscular weakness
● Absent bowel sounds (‘ileus’)
● EKG abnormalities: peaking of T
waves, prolonged P-R interval
● Ventricular fibrillation
● Cardiac arrest

A

Potassium Toxicity: Hyperkalemia

75
Q

Biochemical and morphological changes occur when blood is stored.

This will affect the red cell viability and function. These changes are termed as

A

RBC storage lesion

76
Q

Most frequent infection associated with transfusion

A

TTBI

77
Q

Laboratory evidence of the pathogen in the recipient and demonstration of the pathogen in at least one or more of the following:
○ Transfused component
○ Donor at the time of collection
○ An additional component prepared from the same donation
○ An additional recipient of a component from the same
donation

A

TTBI

78
Q

The predominant bacteria associated with contamination of RBC

A

Gram-negative rods in the family of Enterobacteriaceae

79
Q

The predominant bacteria associated with contamination of platelets

A

Gram-positive cocci usually from the normal skin flora introduced to the product during venipuncture

80
Q

accounts for the greatest number of deaths due to blood product contamination

A

Staphylococcus aureus

platelets

81
Q

Associated with PLATELETS OR RBCs?

Enterobacter cloacae
Escherichia coli
Klebsiella oxytoca
Klebsiella pneumonia
Pseudomonas aeruginosa
Serratia marcescens

A

RBCs

82
Q

Associated with PLATELETS OR RBCs?

Staphylococcus aureus
Staphylococcus epidermidis
Staphylococcus lugdunensis

A

platelets

83
Q

What will you do if you encounter transfusion reactions?

A
  1. The first step is to IMMEDIATELY STOP the transfusion if the infusion is still in process
  2. The next step is to follow the standard procedure to send appropriate specimen to the laboratory for a transfusion reaction investigation

MTAP (11 decks)

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