Blood Transfusions Flashcards
What are the 2 major tests for compatibility of blood transfusions?
ABO compatible
Rh(D): it’s the most immunogenic
What is the major complication of RhD mismatch
Immunization to Rh, which can cause Rh disease of the newborn
What type of antibody are the ABO antibodies?
IgM
What are leukocyte reduced blood transfusions?
Happens here with every transfusion; required in Europe & Canada
Non-LR RBC contain lots of WBC
Doing this reduces febrile reactions, HLA immunization (it’s harder to get a transplant if you’re alloimmunized), effective in reducing CMV transmission, does not prevent GVHD
What are irradiated blood products?
Irradiation –> cross linkage of lymphocyte DNA
cells are unable to replicate & unable to undergo apoptosis
Unable to attack foreign recipient
Prevents graft v. host dz
Great to do for units from relatives bc they’re more likely to share hapolotypes & donor could see recipient as foreign, so owuld attack donor’s body
Also do it for: allogenic HPC transplant recipients, intrauterine transfusion, neonates doing ECMO, Hodgkin’s dz, cellular immune deficiency, solid organ transplants
Cons: expensive, damages rbc a little but Johns Hopkins irradiates everything
When would you give unrossmatched blood?
When exsanguination: pt is about to die due to loss of blood
If you don’t have time for typing, O+ for males, O+ for females beyond childbaring years, O nbeg for females of childbearing years
Crossmatching is done respectively
Which fluids are compatible in a blood transfusion? What’s not compatible?
Normal saline
ABO compatible plasma
NOT lactated ringers (bc they have calcium which counteracts the citrate anticoagulant)
D5W and 0.45% NS: hypotonic solution –> RBC swelling and bursting
Antibiotics/drugs/TPN: hypertonic solution –> RBC shrinkage
RBC risks?
Acute/delayed hemolytic transfusion rections (this is what we fear most)
Allergic/anaphylactic (most common, you can wash RBC with saline to remove antigens from the product)
Febrile nonhemolytic transfusions reactions
TRALI: Transfusoin related lung injury (acute)
TACO: transfusion related cardiac overload
Contaminiated unit/sepsis
Alloimmunization
Graft v. host dz: rare
Posttransfusion purpura- rare
Iron overload
What are the signs and symptoms of hemolytic transfusion reactions? What tests should you order?
Fever, chills, resp distress, hyper/hypotension, abdomina/chest/flank/back pain, pain at infusion site, skin manifestations, jaundice/hemoglobinurea, nausea/vomiting
CBC- H/H
Bilirubin
LDH
Haptoglobin
UA (urine analysis)
DAT (Coombs)
