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CCHS SBB > Adverse Effects of Transfusion > Flashcards

Adverse Effects of Transfusion Flashcards

1
Q

hemovigilance according to AABB

A

collection of information on complications of transfusion, analysis of data, and subsequent data-driven improvement in transfusion practice

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2
Q

main purpose of hemovigilance

A

improve reporting of transfusion related adverse events

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3
Q

when are transfusion related fatalities reported to FDA?

A

ASAP with full written report within 7 days of the event

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4
Q

transfusion reaction signs and symptoms

A

fever 1C, chills, respiratory distress, hyper or hypotension, abdominal/check/flank/back pain, pain at infusion site, skin manifestations, jaundice or hemoglobinuria, nausea or vomiting, abnormal bleeding, oliguria or anuria

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5
Q

2 major groups of transfusion reactions

A

immediate (acute)

delayed

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6
Q

immediate hemolytic (immunologic) reactions

A

intravascular hemolytic

extravascular hemolytic

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7
Q

immediate non-hemolytic (immunologic)

A 
febrile
allergic
anaphylactic
TRALI
posttransfusion purpura
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8
Q

immediate non-immunologic reactions

A

bacterial
circulatory overload
hypothermic

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9
Q

usual cause of acute intravascular hemolytic reaction

A

ABO incompatibility, most often due to clerical error with mislabeling recipient’s pretransfusion sample at collection or failing to match intended recipient with blood product immediately before transfusion

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10
Q

acute intravascular hemolytic reaction clinical symptoms

A 
hypotension
fever
discomfort or anxiety
dyspnea
chills
facial flushing
kidney pain
bleeding from incision sites and mucous membranes
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11
Q

treatment for acute intravascular hemolytic reaction

A

stop transfusion, keep IV line open, give renal and cardiovascular supportive therapy

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12
Q

lab confirmation of acute intravascular hemolytic reaction

A 
positive DAT
Hgb in urine
elevated LDH
elevated bilirubin
decreased haptoglobin
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13
Q

how much ABO incompatible blood is required for acute intravascular hemolytic reaction?

A

as little as 10cc

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14
Q

what causes hemolysis in acute intravascular hemolytic reaction

A

ABO antibodies of patient destroy donor red cells in circulation; antibody binds complement which hemolyzes red cells directly in bloodstream

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15
Q

what is the key even leading to renal failure/hypotension/shock in acute intravascular hemolytic reaction?

A

Ag-Ab complexes cause release of vasoactive compounds (bradykinin) that cause vasodilation –> intravascular volume increases, blood pressure bottoms out and decrease in renal diffusion. Body responds with reflexive vasoconstriction to maintain blood pressure. Kidneys starved for blood

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16
Q

what causes acute extravascular hemolytic reaction?

A

pre-formed IgG antibody in patient
antibody missed or not detected during pre-transfusion testing or antibody identified by antigen positive red cells given

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17
Q

clinical symptoms of acute extravascular hemolytic reaction

A

fever

chills

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18
Q

clinical treatment of acute extravascular hemolytic reaction

A

stop transfusion, keep IV line open, give renal and cardiovascular supportive therapy

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19
Q

lab confirmation of acute extravascular hemolytic reaction

A

positive DAT
elution of antibody
decreased haptoglobin

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20
Q

what causes extravascular hemolysis

A

IgG antibody (other than ABO) of patient attaches to corresponding antigen on donor red cells; coated red cells are removed from circulation by liver and spleen and are destroyed extravascularly

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21
Q

what does posttransfusion sample look like in extravascular hemolytic reaction?

A

icteric due to increase in bilirubin

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22
Q

what does posttransfusion sample look like in intravascular hemolytic reaction?

A

hemolyzed due to hemoglobin release in bloodstream

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23
Q

transfusion reaction due to HLA antibodies in recipient’s serum to HLA antigens on white cells and/or platelets of donor

A

febrile immediate non-hemolytic

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24
Q

clinical symptoms of febrile immediate non-hemolytic reaction

A 
fever
may have mild chills
headache
nausea
nonproductive cough
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25
Q

clinical treatment for febrile reaction

A

stop transfusion; treatment not required as symptoms go away quickly

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26
Q

lab confirmation of febrile reaction

A

negative DAT

negative gram stain/culture

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27
Q

prevention of febrile reactions

A

leukoreduction

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28
Q

onset of febrile reaction

A

during transfusion or up to 24 hours post transfusion

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29
Q

onset of allergic reaction

A

during transfusion or up to 24 hours post transfusion

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30
Q

clinical signs of allergic reaction

A

urticaria with itching
occasional facial swelling
wheezing
no fever

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31
Q

treatment of allergic reaction

A

stop transfusion; give antihistamines and epinephrine

32
Q

prevention of allergic reactions

A

pre-treat with antihistamines

may require washed products

33
Q

incidence of allergic reactions

A

1-3%

34
Q

incidence of febrile reactions

A

0.1-1% with leukocyte reduction

35
Q

reaction due to IgA in donor plasma transfused to IgA deficient recipients with anti-IgA, cytokines

A

anaphylactic

36
Q

clinical signs of anaphylactic reaction

A 
flushing
shock
dyspnea
hypotension
NO fever
37
Q

treatment of anaphylactic reaction

A

stop transfusion
treat symptoms
give epinephrine

38
Q

prevention of anaphylactic reactions

A

washed RBCs or frozen/deglyced RBCs
washed platelets
products from IgA deficient donors

39
Q

incidence of anaphylactic reactions

A

1:20,000-1:50,000

40
Q

reaction due to white cell (HLA) antibodies in donor plasma reacting with recipient’s granulocytes within 6 hours of tranfusion

A

TRALI

41
Q

clinical signs of TRALI

A 
pulmonary edema
hypoxemia
fever
chills
flushing
dyspnea
hypotension
42
Q

treatment of TRALI

A

stop transfusion

immediately administer respiratory support

43
Q

incidence of TRALI

A

1:5000-1:190,000

44
Q

reaction due to platelet antibodies, usually associated with HPA-1a antigen

A

posttransfusion purpura

45
Q

reaction due to bacterial contamination of blood products

A

transfusion-associated sepsis

46
Q

product with highest risk of bacterial contamination

A

pooled products

47
Q

clinical signs of transfusion-associated sepsis

A 
fever
chills
increased pulse
hypotension
shock
48
Q

treatment of transfusion-associated sepsis

A

stop transfusion

give IV antibiotics, treat symptoms

49
Q

bacteria associated with unclean FFP thawing waterbath

A

Pseudomonas

50
Q

bacteria associated with red cell products

A

Yersinia, Serratia

51
Q

bacteria associated with platelet products

A

Staph, Enterobacter

52
Q

inability of patient’s circulatory system to handle increased fluid volume of transfusion

A

TACO

53
Q

clinical symptoms of TACO

A 
dyspnea
cough
neck vein distension
pulmonary congestion
edema
54
Q

clinical treatment of TACO

A

stop transfusion

keep head of bed elevated, nasal oxygen, diuretics

55
Q

resolution of TACO

A

smaller volume transfusions

56
Q

incidence of TACO

A

<1%

57
Q

reaction that can occur after receiving large amounts of cold blood that results in cardiac arrhythmia and cardiac arrest

A

hypothermic

58
Q

types of delayed reactions

A 
delayed hemolytic
GVHD
citrate toxicity
transfusion hemosiderosis
transmission of disease
59
Q

reaction due to reactivated production of antibody in response to foreign RBC antigens

A

delayed hemolytic

60
Q

what kind of hemolysis associated with delayed hemolytic reactions?

A

extraascular

61
Q

clinical signs of delayed hemolytic reaction

A

mild jaundice
fever
drop in Hct

62
Q

antibody associated with delayed hemolytic reactions

A

Kidd

63
Q

incidence of delayed hemolytic reactions

A

1:2,500-1:11,000

64
Q

occurs when immunocompetent donor lymphocytes engraft and multiply in recipient

A

GVHD

65
Q

clinical symptoms of GVHD

A

skin rash, fever, diarrhea, liver failure, bone marrow suppression, death

66
Q

clinical treatment of GVHD

A

none

67
Q

prevention of GVHD

A

irradiated cellular products

68
Q

how to decrease citrate toxicity?

A

calcium administration

69
Q

increased iron deposits due to long-continued transfusion

A

transfusion hemosiderosis

70
Q

diseases associated with transfusion

A 
hepatitis B
hepatitis C
HIV
syphilis
CMV
malaria
71
Q

incubation period of hep B

A

6-26 weeks

72
Q

most common form of hepatitis occurring with transfusion today

A

hep C

73
Q

what products carry increased risk of hep and HIV transmission?

A

pooled components and plasma derived fractions of lyophilized factor VIII and IX

74
Q

what percent of blood donors are said to have CMV infectious leukocytes?

A

6-12%

75
Q

most common cause of acute hemolytic transfusion reaction

A

clerical error resulting in wrong ABO type transfused

76
Q

when is bilirubin most effectively tested after suspected reaction?

A

6 hour post

77
Q

most transfusion associated deaths are caused by?

A

acute hemolysis, anaphylaxis, sepsis, or TRALI

CCHS SBB (40 decks)

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