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Hematology Exam 2 > Lec 17 - Transfusion Reactions > Flashcards

Lec 17 - Transfusion Reactions Flashcards

1
Q

clinical use of Rh immune globulin

A

-prevents problems in future pregnancies

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2
Q

historical significance of autologous donation

A
  • youre more likely to get a transfusion if you donate your own blood for yourself
  • usually donated before the surgery or whatever so the pt is slightly anemic = inc chances of ischemia
  • usually blood isnt tested for viruses as much so then dont know if pt wants his virus laden blood or another donors blood
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3
Q

historical significance of directed donation

A

-donating blood to some one you know

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4
Q

hydrops fetalis basic mechanism and causes

A

imbalance of interstitial fluid production nd lymphatic return (caused by congestive heart failure, obstructed lymphatic flow, decreased plasma oncotic pressure)

body tries to compensate but ultimately increased venous pressure = edema and effusion

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5
Q

consequences of accelerated RBC destruction:

A

hyperbillirubinemia (unconjugated) == kernicterus - yellow staining of the basal ganglia

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6
Q

HDN caused by Rh antigens other than D

A
  • Less immunogenic than D, so less severe

- Anti-E & C are most likely to cause severe HDFN

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7
Q

Which non-Rh antibodies are most likely to cause significant HDFN?

A

Anti-Kell

-Kell antigen present on RBCs & erythroid precursors in marrow

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8
Q

*Consequences of accelerated RBC destruction in HDFN

A
  1. Hydrops fetalis
    - Accumulation of fluid in fetus (edema, effusion etc)
    - Many causes: Rh immunization, congenital heart disease, arrhythmia etc.
  2. Kernicterus: Yellow staining of basal ganglia
    - Hyperbilirubinemia (unconjugated) from RBC destruction; immature liver can’t conjugate all
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9
Q

Hydrops fetalis pathophysiology

A

Imbalanced interstitial fluid production & lymph return-> Body compensation-> ↑Venous P.-> ↑edema & effusion (cycle)

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10
Q

Maternofetal hemorrhage occurs when/how?

A
  • Mostly in last trimester & delivery

- Many other causes (abortion, trauma etc)

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11
Q

*RhoGAM/ Rh immune globulin use & mechanism

A
  • Prevent HDFN
  • Unknown mechanism:
    1. The Anti-D masks antigen sites on fetal Rh+ cells in maternal circulation, preventing recognition
    2. The Anti-D Helps clear antibody-coated Rh+ cells before they can be recognized by maternal immune system
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12
Q

When to administer RhoGAM

A
  1. 28 weeks gestation
    (Rarely Rh alloimmunization before 28wk)
  2. W/i 72hr. of delivery
  3. Possible extra dose if beyond 40wk gestation
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13
Q

Chance of developing Anti-D when D- pt. is transfused w/ D+ blood?

A

20%

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14
Q

*Most common cause of HTR?

A

Clerical error

wrong label, wrong blood hung etc

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15
Q

*Signs/symptoms of Acute intravascular HTR?

A
  1. Fever/chills (80%)
  2. Back/flank/infusion site pain
  3. HypOtension/shock
  4. Hemoglobinuria
  5. “Impending sense of doom”
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16
Q

Tx of acute intravascular HTR

A
  • Hydration/diuresis (protect kidneys)

- Consider RBC exchange for high volume incompatible transfusions

17
Q
  • Most frequently reported transfusion reaction (FNHTR)
  • Sign/symptoms
  • Tx
A

Febrile Non-hemolytic transfusion reaction

  • Unexplained ↑temp. of 1C+, Chills, rigors
  • Premedicated FNHTR (acetaminophen) can still have chills but not fever
  • Tx= Acetaminophen
18
Q

*Schistocytes are present in ______ hemolysis

A

Intravascular
-Antibodies->complement->lysis
helmet cells

19
Q

most important factor when patient is having a hemolytic reaction to trasnfusion?

A

HOW MUCH BLOOD DID THEY GET?

STOP THE TRANSFUSION!

20
Q

What kind of RBC are present in extra vascular hemolysis?

A

SPHEROCYTES

-In extravascular, IgG coats-> Spleen/liver phagocytosis

21
Q

TACO is

A

a circulatory overload - gets better with diuretics

22
Q

TRALI is associated with

A

fever

does not get better with diuretics

23
Q

septic transfusion reaction most commonly involves…?

A

endotoxin making gram neg rods (yersinia or E Coli) from the donors blood

24
Q

platelets stored at room temp most commonly have what organsims?

A

gram pos cocci (staph epi and staph aureus)

another type of septic transfusion reaction

25
Q

symptoms of septic transfusion reaction?

A

fever
RIGORS (NOT CHILLS - MUSCLE TENSE UP A LOT!)
shock

Hematology Exam 2 (10 decks)

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