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Transfusion > Adverse Effects of Transfusion > Flashcards

Adverse Effects of Transfusion Flashcards

1
Q

How fast does an acute TR happen?

A

within hours

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2
Q

How fast does a delayed TR happen?

A

days to weeks

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3
Q

What are examples of causes for infectious transfusion reactions?

A
  • Bacterial Contamination
  • Viral
  • Parasitic blood borne agents
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4
Q

What are examples of Acute immune mediated TR?

A
  • Hemolytic
  • Febrile
  • Allergic
  • Anaphylactic
  • TRALI
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5
Q

What are examples of Acute Non- immune mediated TR?

A
  • Sepsis
  • TACO
  • Physical hemolysis (collection)
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6
Q

What are examples of Delayed Non- immune mediated TR?

A
  • Hemosiderosis
  • Citrate toxicity
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7
Q

What are examples of Delayed immune mediated TR?

A
  • hemolytic
  • serologic : RBC
  • HLA alloimmune
  • TA - GVHD
  • post transfusion purpura
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8
Q

Which RBC antigens are most likely to have AB developed against in some lacking the AG? In order!

A
  • Anti-D (85%)
  • Anti-K (10%)
  • Anti-E (7%)
  • Anti-c (3%)
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9
Q

Between IgG and IgM which out of the two is most likely to bind complement the most often?

A

IgM

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10
Q

During a TR complement can be activated and what three thing’s occur during that cascade?

A

1) Opsonization
2) Anaphylatoxins induce inflammation
3) Cell lysis - complement completion (MAC)

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11
Q

What are the cardinal signs of DIC?

A
  • Consumption of clotting factors
  • consumption of PLT
  • Diffuse uncontrolled vascular bleeding
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12
Q

Why might a person experiencing an HTR also experience shock and renal failure?

A

The loss of blood volume can cause hypotension allowing thrombi to form in the kidneys.

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13
Q

Which antibodies are commonly involved in extravascular hemolysis.

A

anti-JKa , Fya, K,

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14
Q

What is a transfusion reaction?

A

any adverse outcome associated with infusion of blood or blood components.

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15
Q

What is intravascular hemolysis?

A

destruction of transfused RBC due to immunological / non-immunologic
usually ABO imcompatible

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16
Q

what is extravascular hemolysis?

A

premature removal of incompatible transfused RBC from circulation by phagocytic cells of the reticuloendothelial system.

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17
Q

What is an anaphylatoxin?

A

Substance stimulated relase of mediators (histamine) from mast cells and Basophils which cause symptoms of immediate sensitivity independent of IgE.

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18
Q

What is histamine?

A

Substance produced from AA histidine, increases gastric secretions, dilation of capillaries & contracts bronchial smooth muscle.

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19
Q

What are leukotrienes?

A

Series of compounds that regulate allergic reactions and inflammatory responses.

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20
Q

What is Serotonin?

A

A potent vasoconstrictor

21
Q

what is Hemoglobinemia?

A

Presence of free HgB in plasma

22
Q

What results do you expect in an AHTR

A
  • increased Bili
  • decrease Haptoglobin
  • Plasma - discoloured
  • DAT (+) possibly (-)
23
Q

How are AHTR managed?

A

1) pump the PT with 0.9% saline & diuretic to increase output.
2) Manage consumption coagulopathy

24
Q

What is a febrile NHTR?

A

fever increase >1 C above the PT baseline, usually subsides to antipyretics.

25
Q

What is an antipyretic? and whats an example.

A
  • Acetominophen, agent which reduces fevers
26
Q

Why do we prefer acetominophen over aspirin.

A

because acetominophen doesn’t affect PLT.

27
Q

How can febrile reactions be prevented?

A
  • Administer antipyretics before transfusion
  • leukoreduced blood components
28
Q

What are cytokines?

A

Hormones produced by WBC which communicate to other immune cells to fight infection or reject something from the body.

29
Q

How are allergic reactions managed?

A
  • Antihistamine admin
  • if symptoms subside transfusion can continue
  • more aggressive reactions require discontinuation and aggressive treatment.
30
Q

How can allergic reactions be prevented?

A

Pre -treat with anti-histamines
- request washed cells

31
Q

What is an anaphylactic reaction?

A

Rapid life threatening allergic reaction which only requires few mL of components to initiate. Usually related to a patient lacking in IgA.

32
Q

How can anaphylactic reactions be managed?

A
  • discontinue unit
  • Epinephrine subcutaneous admin
33
Q

How can anaphylactic reactions be avoided? and what complication occurs with this particular NHTR

A
  • Units Lacking IgA (might have to be autologous)
  • Washed unit

-> PT with IgA def/ anaphylactic reactions aren’t diagnosed until it happens, unless PT’s family history implies there may be a genetic association.

34
Q

What does TRALI stand for?

A

Transfusion related acute lung injury

35
Q

What is TRALI?

A
  • acute respiratory insufficiency following infusion.
  • X-ray show pulmonary edema and no cardiac failure.
  • Associated to passively transfused HLA Ab’s.
36
Q

What are common symptoms of TRALI?

A

Chills
fever
tachycardia
hypotension
dyspnea
cyanosis
hypoxemia

37
Q

What is the DAT for TRALI?

A

DAT (-)
No hemolysis

38
Q

How can TRALI be prevented?

A
  • use Leukoreduced products
  • These patients cannot be used to manufacture plasma components
39
Q

Which administerable drug shows little to know value when treating TRALI?

A

steroids

40
Q

What are the three common bacteria which can contaminate units at 4C?

A

Yersinia.enterocolitica
Serratia.liquefacien
Pseudomonas.fluorescence

41
Q

How is bacterial contaminated unit that was transfused managed?

A
  • PT on a broad spectrum Antibiotic, Blood cultures
  • LAB: investigates the whole unit, may be cultured as well.
42
Q

Which bacteria are more likely to contaminate a unit of PLT and why?

A
  • Staphylococcus. spp
  • Bacillus. cereus
    Because PLT are stored at RT
43
Q

Which common antibodies are involved in delayed HTR?

A

c, E, C, Kidd, Duffy, Kell

44
Q

What reactions can you expect from a delayed HTR?

A

DAT (+) 3-7 days past transfusion
MF pattern reaction

45
Q

How to prevent a delayed HTR?

A
  • impossible
  • Give Ag negative Blood
46
Q

What is Transfusion associated GvHD?

A

Donor attack the cells if the PT, increasing the PT susceptibility to infections.

47
Q

How can TA-GvHD be prevented?

A

gamma irradiated cellular components : bc leukoreduced isn’t enough

48
Q
A
49
Q
A

Transfusion (3 decks)

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