Job Interview Flashcards
A patient has a fever during a transfusion of 1C, from 37 baseline to 38C. What could this indicate?
Fever is the most common sign of acute haemolytic transfusion reaction. However, fever may be unrelated to the transfusion.
(If Tx Rx, = Febrile, non haemolytic transfusion reaction).
A patient has chills with or without rigors during a transfusion. What could this indicate?
Possible bacterial contamination. Suggest blood cultures on patient and suspected units.
(Transfusion Reaction)
A patient has tachycardia during a transfusion. What could this indicate?
Possible bacterial contamination. Suggest blood cultures on patient and suspected units.
(Transfusion Reaction)
A doctor suspects transfusion reaction on their patient, and orders Tx Rx Ix. Lab testing shows no evidence of red cell incompatibility. What could this mean?
Haemolytic transfusion reaction has been excluded, but still could be a Tx Rx; immunological or non-immunological.
A patient has shortness of breath during a transfusion. What could this indicate?
Possible bacterial contamination. Suggest blood cultures on patient and suspected units.
(Transfusion Reaction)
Following a transfusion of units, a patient develops hives/a rash. They have no other symptoms, what could be the cause?
A suspected allergic reaction to the unit, <2/3 would be a suspected minor reaction
>2/3 would be a suspected severe reaction
(Transfusion Reaction)
Following a transfusion of units, a patient develops hives/a rash AND has anxiety and chest pain, what could this indicate?
A suspected anaphylactic reaction to the unit, notify haematologist. Suggest testing for IgA levels and anti-IgA antibodies.
(Transfusion Reaction)
Following a transfusion of units, a patient develops hives/a rash AND has shortness of breath, low blood pressure and coughing, what could this indicate?
A suspected anaphylactic reaction to the unit, notify haematologist. Suggest testing for IgA levels and anti-IgA antibodies.
(Transfusion Reaction)
Within 15 minutes of receiving a transfusion of units, a patient develops shortness of breath, wheezing and coughing, what could this indicate?
A suspected anaphylactic reaction to the unit, notify haematologist. Suggest testing for IgA levels and anti-IgA antibodies.
(Transfusion Reaction)
60 minutes after receiving a transfusion of units, a patient develops shortness of breath, wheezing and coughing, what could this indicate?
Suspected transfusion associated circulatory overload; notify haematologist. Suggest BNP testing.
(Transfusion Reaction)
3 hours after receiving a transfusion of units, a patient develops shortness of breath, wheezing and coughing, what could this indicate?
Suspected transfusion related lung injury; notify haematologist. Suggest HLA testing on patient and donor.
(Transfusion Reaction)
5 hours after receiving a transfusion of units, a patient develops shortness of breath, wheezing and coughing, what could this indicate?
Suspected transfusion related lung injury; notify haematologist. Suggest HLA testing on patient and donor.
(Transfusion Reaction)
What are some signs which may indicate bacterial contamination of a unit that has been transfused?
High fever, rigors/chills, low blood pressure, tachycardia, nausea/vomiting, shortness of breath, circulatory collapse
What are some signs which may indicate that a patient may be reacting to a unit that has been transfused?
Fever
Rigors/chillsRespiratory distress (wheezing/coughing/SOB)
Change in blood pressure (high or low)
Pain in the abdomen/chest/back or infusion site
Uritcaria (skin rash)
Jaundice or blood in the urine
Nausea/vomiting
Abnormal bleeding
Small amounts of urine
Within 24 hours, a patient has symptoms of a transfusion reaction. What could be the cause?
It could be an acute immunological or acute non-immunological cause.
Acute immunological = acute haemolytic TR, febrile haemolytic TR, mild or severe allergic reaction, or TRALI
Acute non-immunological = complication of massive transfusion, non-immune mediated haemolysis, bacterial infection, TACO
24 hours after transfusion, a patient has symptoms of a transfusion reaction. What could be the cause?
Delayed HTR, post-transfusion purpura, TA-GvHD, alloimmuniation of RBC or HLA antigens, transfusion-related immune modulation
A patient has a history of a low incidence antibody (e.g. Kpa, Cw) and the screen cells are negative. Do we continue further testing to show the antibody is reactive?
Only if pregnant.
A patient has a complex antibody investigation, and some antibodies can’t be fully excluded. Explain how you would provide blood for that patient.
Serologically phenotype the unit to ensure it is NEGATIVE for the undetermined antigen.
During serological crossmatching, a unit is unexpectedly incompatible. Outline what you would do next?
Run a DAT on the unit; if it is positive try to obtain an alternative unit to crossmatch for the patient and inform ARCBS so they can update the donor file/discard the red cell.
A patient has a complex antibody investigation, and ARCBS can’t find phenotype matched units for the patient. Explain how you would provide blood for that patient.
Ideally, check millennium/private labs to see if they have phenotype matched blood they could send us.
Incompatible or least reactive red cells may need to be issued following senior scientist/haematologist approval.
A screen and panel are positive, but there are few, weak reactions. How would you continue your investigation?
Possible HLA reaction or a weak Ab
Consider changing the phase of the testing to enhance antibody reactivity; e.g. testing by enzyme/PEG technique or room temperature.
A screen and panel are positive, showing non-specific panagglutination. How would you continue your investigation?
Are the reactions strong or weak?
* Variable reactions could be warm auto, additive, or multiple or high frequency antibodies.
* Weak reactions could be rouleaux, warm auto (DAT +), HTLA.
- Enzyme and DTT screen excludes mAb, but a warm auto will be enhanced.
- TTH IAT saline phase will show rouleaux and, unless LISS additive, exclude additive.
A patient has a history of [RhK, Fy, Jk, Ss] antibody. Do you need to serologically crossmatch?
Yes, whether reactive or not. Also phenotype the unit as negative.
A patient has a history of M antibody. Do you need to serologically crossmatch?
Only if anti-M is currently reactive; if historic Rx M- is best practice but random units are fine.
