Blood Transfusion

Question 1

What is the universal blood donor for red cells?

Answer 1

O negative!

Question 2

What is the universal recipient for red cells?

Answer 2

AB+

Question 3

What is the classic presentation of acute hemolytic transfusion reaction?

Answer 3

This usually occurs within 15 minutes of receiving the blood with fever right away. They will have hemoglobinemia/hemoglobinuria. Classic case-ABO incompatibility.

Question 4

What is the timeline of symptom of delayed hemolytic transfusion rxn? What test will be positive?

Answer 4

The symptoms occur after 24 hours, usually 7-10 days later. DAT will be positive

Question 5

What is the reason behind why delayed hemolytic transfusion rxn is delayed?

Answer 5

The antibody titer at the beginning is too low to be detected at pre-transfusion testing, after receiving the transfusion the antibody slowly increases to cause hemolysis

Question 6

What is the differential of a febrile transfusion reaction?

Answer 6

Acute Hemolysis, FNHR, and septic transfusion Rxn

Question 7

What is the mechanism of action in febrile hemolytic transfusion rxns?

Answer 7

Febrile reactions are due to patients HLA or anti-white blood cell (granulocyte) antibodies. Cytokines are then released.

Question 8

What are the clinical features of an allergic transfusion reaction?

Answer 8

Hives/skin rash, difficulty breathing, anaphylaxis

Question 9

What is a tactic you can use to prevent febrile hemolytic transfusion reactions?

Answer 9

By using leukocyte depleted blood

Question 10

What is a tactic you can use if patients continue to have severe allergic reactions to blood?

Answer 10

Washed RBCs can be utilized for persistent severe allergic reactions.

Question 11

What role does washing RBCs play in treating those who develop severe anaphylaxis to blood transfusions? What is the mechanism of the anaphylaxis?

Answer 11

This is helpful to get rid of anti-IgA antibodies. This severe type of rxn occurs in patients with IgA def.

Question 12

What are the clinical features of TRALI?

Answer 12

They have clinically ARDS: severe hypoxemia plus non-cardiogenic pulmonary edema. Initially high BP followed by low BP. Severe pulmonary edema on CXR.

Question 13

What is the mechanism of action of why TRALI occurs?

Answer 13

It is due to anti-granulocyte/HLA antibodies passively administered in blood products.

Question 14

What is the time line of symptoms in TRALI?

Answer 14

Symptoms can occur as early 15-20 mins after the infusion. Usually occur 4-6 hours after.

Question 15

Why does transfusion assoc GVHD occur?

Answer 15

There are T cells in the donor product that are attacking the recipients native immune system

Question 16

What type of patients does transfusion assoc GVHD occur in?

Answer 16

Those that have congenital immunodeficiency or severely immunosuppressed (BMT, lymphoma, leukemia undergoing induction tx).

Question 17

How do you differentiate TACO from TRALI?

Answer 17

TRALI is not associated with an elevated (BNP) or N terminal Pro-BNP (NT Pro-BNP), central venous pressure, or pulmonary artery wedge pressure. W/taco you see this.

Question 18

What platelet antigens are related to platelet refractoriness?

Answer 18

HLA class 1 antigens

Question 19

What is the antigen involved in post-transfusion purpura?

Answer 19

HPA-1 antigen

Question 20

What is the time line of symptoms seen with post-transfusion purpura?

Answer 20

It can occur as early as 24 hours but average is 7-10 days, thrombocytopenia develops rapidly.

Question 21

What is the treatment of PTP?

Answer 21

IVIG

Question 22

When you have ABO incompatibility with stem cell transplantation what is the patient at risk of developing?

Answer 22

acute hemolysis, delayed engraftment for stem cell transplant, and PRCA.