Blood transfusions Flashcards
Who gets (gamma) irradiated RBCs?
- bone marrow transplant recipients (after or awaiting transplant from HLA identical pt),
- People with Hodgkin’s or prior fludarabine chemo
- acquired or congenital cellular immunodeficiency
- blood components donated by 1st or second degree relatives
- anyone at risk for Graft vs host dx (gamma rays prevent graft dx)
Who gets leukoreduced RBCs?
prevents primary alloimmunization to HLA antigens
- chronically transfused patients
- CMV seronegative at risk pts (AIDS, transplant patients),
- potential transplant recipients
- previous febrile non hemolytic transfusion reaction pts
who gets washed RBCs?
IgA deficiency pts
complement dependent autoimmune hemolytic anemia
continued allergic reactions (hives) with red cell transfusions despite anti-histamine treatment
Why do we have all these special preparations for RBCs?
because as RBCs are transfused with other components like plasma or WBCs or have lymphocytes that can potentially harm pts.
What is leukoreduced blood and what is the benefit of leukoreduced RBCs?
who gets leukoreduced blood?
NOT THE SAME THING AS “WASHED” - means to remove the plasma from RBCs
Leukoreduced means = they separate out the WBCs from RBCs.
PRBCs may also have small amounts of WBCs or debris present in the separation process. Can cause febrile transfusion reactions or HLA alloimmunization. Also lowers CMV transmission because CMV resides in WBCs and can be transmitted in transfusion.
Also give to AIDS pts or people without CMV.
Does leukoreduction remove all lymphocyte components?
no. Therefore there is irradiated RBCs given. Gamma radiation can essentially kill all living lymphocytic components (T cells) this is useful for pts who are at risk for transfusion associated graft versus host disease -
what is transfusion associated graft versus host disease -
rare but fatal complication from the engraftment and proliferation of donor T lymphocytes into the transfused recipient
Who needs desensitization to HLA and ABO antigens?
certain patients who are difficult to transfuse due to their broad immunogenicity
what does washed RBCs mean?
they remove as much plasma from RBCs as possible.
what does irradiated RBCs mean
Gamma radiation is done to destroy lymphocytes components so they cannot affect the donor and cause a transfusion associated graft versus host dx (in bone marrow transplant pts)
transfusion associated graft versus host disease happens when
seen when donor lymphocytes from transfused blood attack host tissue.
This happens in all immunocompromised (hodgkin lymphoma with recent chemotherapy) or those who are a partial HLA match to donor (family member)
transfusion associated graft versus host disease manifestations
4-30 days post transfusion with fever, erythematous maculopapular rash that often becomes generalized and additional features include anorexia, right upper quadrant abdominal pain, hepatomegaly, and liver function abnormalities and profuse watery diarrhea >708 L per day
transfusion associated GVHD also causes this to bone marrow
destroys bone marrow leading to progressive pancytopenia and this is a major source of morbidity and mortality
prognosis of GVHD related to transfusions
treatment is typically ineffective and most cases 80-90% are fatal.
Therefore prevention is paramount. Those at risk for condition for get irradiated blood products to inactivated donor lymphocytes prior to transfusions
are patients with HIV at risk for transfusion associated graft versus host disease?
no because HIV alters donor lymphocyte survival
