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Hematology > Blood Component therapy II > Flashcards

Blood Component therapy II Flashcards

1
Q

What is the pathophysiology of transfusion related acute lung injury? (2 hits)

A

PMN sequestration and priming–where they respond to a weak stimulus in the lungs

PMN activation and ROS generation

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2
Q

What are the antibodies that are involved in TRALI?

A

Anti-HNA

Anti- HLA

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3
Q

What is the presentation of TRALI?

A

Less than 6 hours after transfusion

Dyspnea/hypotension

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4
Q

What are the official diagnostic criteria for TRALI? (4)

A

No evidence of acute lung injury prior to transfusion

Onset within 6 hours of transfusion cessation

Hypoxemia

Bilateral infiltrates

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5
Q

What is the leading cause of transfusion related mortality in the US?

A

TRALI

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6
Q

What is the treatment for TRALI?

A

O2 supplementation

Pressors

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7
Q

SHould you give diuretics for TRALI? TACO?

A

Yes for taco, no for TRALI

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8
Q

How do you prevent TRALI?

A

only allow donors who are at minimal risk for HLA/HNA antibodies

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9
Q

Who are the donors who are at low risk of giving blood that can cause TRALI?

A

Males

nulliparous females

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10
Q

Which has hypotension, and which has elevated BP: TACO vs TRALI

A 
TACO = increased
TRALI = lower
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11
Q

Who is most at risk of developing TACO?

A

Pts already at risk for volume overload

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12
Q

What is the pathophysiology of acute hemolytic TR?

A

Antibodies in the pt against antigens on the transfused RBCs, leading to intravascular destruction

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13
Q

Is acute hemolytic TR intravascular, or extravascular?

A

Intravascular

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14
Q

How does acute hemolytic TR present? (3)

A

Hypotension
CVA TTP (kidney dmg)
red/dark urine

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15
Q

How do you treat acute hemolytic TR?

A

Stop transfusion
IVF
Treat hypotension

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16
Q

How do you prevent hemolytic TR?

A

Prevent clerical errors

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17
Q

What is the pathophysiology of delayed hemolytic TR?

A

Pt has a lower titer of ab and recent transfusion is causing an increase

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18
Q

What is the classic antibody that is seen in delayed hemolytic TR?

A

anti-Kidd

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19
Q

Is delayed hemolytic TR extravascular or intravascular?

A

Extravascular

20
Q

How long does it take for delayed hemolytic TR to present?

A

days-weeks

21
Q

Extravascular hemolysis presents how?

A

Jaundice, leukocytosis

22
Q

What is the treatment for delayed hemolytic TR?

A

Supportive

Correct anemia

23
Q

What is the pathophysiology of posttransfusion purpura?

A

pt has anti-platelet antibodies d/t previous exposure to foreign platelets (prego)

24
Q

How long does it take for posttransfusion purpura to present?

A

9 days ish

25
Q

What are the symptoms of posttransfusion purpura/

A

thrombocytopenia
Purpura
Bleeding

26
Q

Mortality associated with posttransfusion purpura is usually caused by what?

A

Intracranial hemorrhage

27
Q

What is the treatment for posttransfusion purpura?

A

IVIG

28
Q

What is the pathophysiology of transfusion associated GVHD?

A

Blood component donor has a different HLA-type from the recipient

T cells in the component attack host’s HLA cells

29
Q

Who is at risk of developing TA-GHD?

A

immunocompromised

30
Q

How does TA-GVHD present? (3) How long?

A

3-30 days post transfusion

Enterocolitis
elevated LFTs
Maculopapular rash

31
Q

What percent of TA-GVHD are fatal?

A

90%

32
Q

The risk of developing TA-GVHD is higher or lower with a very diverse population?

A

Lower

33
Q

How do you treat TA-GVHD?

A

Nothing successful

34
Q

How do you prevent TA-GVHD? What is the issue with this?

A

Irradiate RBCs–decreases shelf life of blood

35
Q

How long does it take for TTBI to present?

A

immediate to 5 hours

36
Q

TTBI is usually associated with giving what blood component? Why?

A

Platelets

Since they are stored at room temp

37
Q

What is the presentation of TTBI?

A

Fever

38
Q

Which type of bacteria cause a more severe rxn: gram positive or negative?

A

Negative (LPS)

39
Q

To be considered 100% diagnostic for TTBI, what must you do?

A

Identify same bacteria in blood cultures as the transfused blood component

40
Q

Why is it that you have to throw out the first few milliliters of blood taken?

A

Get rid of skin plug

41
Q

How do you prevent TTBI?

A

Culture platelets for 24 hours, and ensure negative

42
Q

What are the TRs that present with a fever?

A 
Febrile
TRALI
Acute hemolytic
TA-GVHD
TTBI
43
Q

What is erythroblastosis fetalis?

A

Hemolytic disease of the newborn

44
Q

What is RHOgam?

A

anti D antibody, that will bind to fetal RBCs, and in maternal blood, and prevents immune response from mom

45
Q

Can you give RHOgam in moms who’ve already had HDNB

A

No

46
Q

In what clinical situations is RHOgam given?

A

threatened abortion
Ectopic
Fetal death in the 2nd or 3rd trimester

Hematology (32 decks)

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