Blood Banking Transfusion Reaction

Question 1

Transfusion Reaction Investigation Work-up

Answer 1

Clerical Check
Visual inspection
DAT
Repeat ABO/Rh
Repeat Compatibility
Repeat crossmatch
Bilirubin test
Check urine
Hemosiderin check
Hemoglobin and hct check

Question 2

Specimen contains 20mg/dL free Hgb

Answer 2

Pink Plasma

Question 3

Specimen contains >100 mg/dL free Hgb

Answer 3

Red plasma

Question 4

Plasma Hgb over ___ can be detected by the naked eye

Answer 4

25mg/dL

Question 5

Maximum concentration of bilirubin after hemolysis will be evident in blood approximately ____ after transfusion

Answer 5

3-6 hours

Question 6

First voided specimen is checked for _____ and ______.

Answer 6

free Hb and urobilinogen

Question 7

_____ can be found weeks after transfusion reaction (PBS)

Answer 7

Hemosiderin

Question 8

Possible causes of HTR or Hemolytic Transfusion Reaction

Answer 8

Antibody binding to RBC
Release of anaphylatoxin
Activation of cytokines
Activation of the coagulation cascade

Question 9

Occurs very soon during/just after transfusion
Reaction occurs within first 24 hours
Most severe HTR: usually caused by ABO incompatibility
S/s: Fever with back pain

Answer 9

Immediate HTR

Question 10

Resolution for immediate HTR

Answer 10

Considered medical emergency
Stop transfusion and induce diuresis by administering mannitol or potassium sparring diuretics

Question 11

Resolution for immediate HTR

Answer 11

Considered medical emergency
Stop transfusion and induce diuresis by administering mannitol or potassium sparring diuretics

Question 12

Effects on blood in immediate HTR

Answer 12

Increased plasma-free Hb
Increased bilirubin
Decreased Haptoglobin
(+)/(-) DAT

Question 13

Associated with an anamnestic response in a patient who has previously been sensitized by transfusion, pregnancy or transplant
May be diagnosed 7-10 days up to 14 days after transfusion
S/s: Jaundice and decreasing hematocrit levels

Answer 13

Delayed HTR

Question 14

Common ab implicated is ANTI-Jka, Anti-E, Anti-D, Anti-C, Anti-K, anti-Fya, and anti-M

Answer 14

Delayed HTR

Question 15

Effects on blood in Delayed HTR

Answer 15

Decreased Hb and Hct
(+)DAT
(+) Post-transfusion antibody screen

Question 16

Damage due to intravascular lysis by hypertonic or hypotonic solution

Answer 16

Physical damage

Question 17

Damage cause by blood warmers

Answer 17

Heat damage

Question 18

Damage brought about by the absence of cryopreservatives

Answer 18

Freeze damage

Question 19

Damage done by blood pumps, roller pumps, infusion under high pressure through small bore needles

Answer 19

Mechanical damage

Question 20

Most commonly encountered type of Transfusion reaction
Manifestation is fever only. A 1-degree celcius rise is associated with transfusion and without any other explanation
Caused by anti-leukocyte antibodies
Administrate leukoreduced components and remove all plasma before transfusion

Answer 20

Febrile NHTR

Question 21

Manifestations are hives and pruritus

Answer 21

Allergic/urticarial transfusion reaction

Question 22

Passive transfer of donor plasma which contains foreign protein (allergen) that reacted with patient IgE/IgG
Prevention = administer washed components
Treatment = administer antihistamine

Answer 22

Allergic/urticarial transfusion reaction

Question 23

Clinical signs (namely hypotension and shock) are seen suddenly after infusion of only a few mL of blood component (Often before 10mL of plasma has been infused)

Answer 23

Anaphylactic transfer reaction

Question 24

Transfusion of IgA-positive blood to an IgA deficient recipient with anti-IgA
Prevention = removing plasma/washed components and transfuse components from IgA deficient donors

Answer 24

Anaphylactic transfer reaction

Question 25

Bilateral pulmonary edema, hypotension. Increased respiratory distress shortly after transfusion

Answer 25

TRALI or Transfusion-related acute lung injury

Question 26

TRALI occurs within ____ of a plasma-containing transfusion

Answer 26

6 hours

Question 27

Prevention of TRALI

Answer 27

Transfuse of leukoreduced components

Question 28

Air allowed into infusion equipment or bood in open system infused under pressure causing air bubble

Answer 28

Air embolism

Question 29

Rapid infusion of large volume of blood products- Iatrogenic

Answer 29

TACO or Transfusion-associated circulatory overload

Question 30

Prevention of TACO

Answer 30

Slower rate of infusion 100mL/hr and split into aliquots

Question 31

Treatment for TACO

Answer 31

Intravenous diuretics Therapeutic phlebotomy O2 therapy

Question 32

Signs and symptoms of: Shaking chills Hemoglobinuria DIC Oliguria/anuria 2-degree celcius increase in body temp.

Answer 32

Transfusion-associated sepsis

Question 33

Causative agents for Transfusion-associated Sepsis

Answer 33

Y. enterocolitica S. liquefascens P. fluorscence P.aeruginosa E.coli

Question 34

Prevention for Transfusion-associated sepsis

Answer 34

Visual inspection of unit before transfusion (Check for brown or purple discoloration, hemolysis, clots, cloudiness)

Question 35

Treatment for Transfusion-associated sepsis

Answer 35

Introduce broad spectrum antibiotics to IV

Question 36

Cause: prior exposure to blood components

Answer 36

Alloimmunization

Question 37

Prevention of Alloimmunization

Answer 37

Matching of donor RBC phenotypes Matching of donor WBC phenotype

Question 38

Anamnestic production of platelet antibodies

Answer 38

Post transfusion purpura

Question 39

Most commonly involved Antibody in PTP or Post Transfusion Purpura

Answer 39

Anti-Human Platelet Ag-1

Question 40

Prevention for PTP

Answer 40

Future transfusion should consist of platelet negative for antigen

Question 41

The proliferation of T lymphocytes from donor blood responding to HLA in the patient

Answer 41

TA-GVHD

Question 42

Prevention of TA-GVHD

Answer 42

Irradiation

Question 43

Transfusion hemosiderosis Present in patients with aplastic anemia, congenital hemolytic anemia, thalassemia, chronically transfused patient

Answer 43

Iron overload

Question 44

Prevention of Iron overload

Answer 44

Transfuse neocyte or neocyte-enriched blood cells

Question 45

Treatment for Iron overload

Answer 45

Iron chelating therapy Deferoxamine Desferoxamine

Question 46

Caused by massive transfusion and prevention is via negation of calcium chloride and calcium gluconate solution

Answer 46

Citrate toxicity