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Block 8 - Autoimmunity, Neoplasia, and Hematologic Disease > PTN - Transfusion Medicine (Squires) > Flashcards

PTN - Transfusion Medicine (Squires) Flashcards

1
Q

What are the two types of donor recruitment and which of these is less likely to transmit infectious disease?

A

Volunteer and paid donors

Volunteer donors less likely to pass on infectious diseases in blood because no incentive to give other than to do good.

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2
Q

True or False: Volunteerism contributes to very occasional blood shortages.

A

True

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3
Q

What 4 components of the medical history of a donor are assessed during the donor screening phase of blood components?

A
  1. Blood pressure
  2. Heart rate
  3. Cardiac disease
  4. History/exposure to certain infectious diseases (hepatitis, HIV, etc.)

BP and HR are taken to ensure that the patient is healthy enough to handle the physical effects of donating blood.

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4
Q

What are the three types of blood collection?

A
  1. Allogeneic
  2. Directed
  3. Autologous
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5
Q

What is a directed donation?

A

Intended recipient of transfusion, or physician, selects a specific donor

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6
Q

What is an allogeneic donation?

A

Routine community blood donation

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7
Q

What are the 6 blood components?

A
  1. Whole blood
  2. Red blood cells
  3. Platelets
  4. Frozen Plasma
  5. Cryoprecipitate
  6. Granulocytes
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8
Q

What 2 types of tests are performed on donor blood to ensure that the recipient does not suffer any consequences of a transfusion?

A
  1. Blood typing and blood group antibodies - ABO and Rh antigen
  2. Infectious disease testing - HIV, Hep B/C, syphillis, HTLV, West Nile virus, etc.
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9
Q

What is apheresis donation?

A

Apheresis uses a machine to collect specific components while the remainder of the blood is returned to the donor.

Allows donors to only donate plasma, platelets, or RBCs.

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10
Q

How are whole blood donations separated into various components?

A

Centrifugation

Separates whole blood into plasma (cryoprecipitate), buffy coat (with WBCs and platelets), and erythrocytes

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11
Q

What 3 blood components are prepared using apheresis?

A
  1. Platelets
  2. Frozen plasma
  3. Granulocytes
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12
Q

What 4 blood components are isolated from whole blood?

A
  1. Red blood cells
  2. Whole blood derived platelets
  3. Frozen plasma
  4. Cryoprecipitate
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13
Q

What are the 4 types of factor concentrates that are commercially available?

A
  1. Factor VIII
  2. Factor IX
  3. Factor VIIa
  4. Prothrombin complex concentrate (PCC) - factors II, VII, IX, and X (vitamin K dependent factors)
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14
Q

What two molecules make up the B antigen on type B RBCs?

A

Fucose and D-galactose

Remember that type O blood only has fucose.

Type A has fucose and N-acetylgalactosamine

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15
Q

When ABO typing, what 2 blood components must be tested?

A
  1. Red blood cells - antigens
  2. Plasma - plasma antibodies
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16
Q

What is reverse typing of blood?

A

Reverse typing occurs when the patient’s serum is tested for anti-A or anti-B antibodies.

Patient serum mixed with commercial A or B RBCs to see if reaction occurs

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17
Q

What is typing discrepancy?

A

When the forward and reverse typing do not agree.

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18
Q

What is Bombay Blood Type and is it possible for a person with this blood type to receive a transfusion?

A

Bombay phenotype is an autosomal recessive inheritance that results in lack of H antigen.

Anti-H antigen forms, which mounts attack against types A, B, and O blood, leading to hemolysis.

Only other bombay blood can be used in transfusion.

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19
Q

What are the 3 most critical Rh blood groups?

A
  1. D antigen
  2. E antigen
  3. C antigen
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20
Q

A patient with RBCs that test positive for anti-A and anti-D has what type of blood?

A

A+

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21
Q

How are anti-D antibodies formed in an Rh negative individual?

A

Anti-D IgG antibodies develop when an Rh negative individual is exposed to Rh positive blood

2 ways:

Pregnancy and transfusion with Rh positive blood

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22
Q

What is the Rh null phenotype and what Rh type do these individuals test as.

A

Rh null phenotype is characterized by no Rh antigens at all.

Typing of these individuals will lead to Rh negative result.

Hemolytic anemia and elevated bilirubin indicate Rh null

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23
Q

Which two blood products do not require the donor and recipient to be an ABO match?

A

Platelets and cryoprecipitate

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24
Q

What two pre-transfusion tests need to be done before blood components are selected and administered?

A
  1. ABO and Rh testing
  2. Serum antibody testing
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25
Q

Which two blood products should be given as Rh negative to women of child-bearing years? Why?

A

Platelets and Granulocytes

Women in their child bearing years who happen to be Rh negative could develop anti-D antibodies if given Rh positive blood. This could lead to complications if she were to get pregnant.

26
Q

What two surface markers on RBCs does a direct antiglobulin (direct Coomb’s) test?

A

C3d and IgG

27
Q

What are 4 clinical conditions associated with a positive direct Coomb’s test?

A
  1. Hemolytic transfusion reactions - from transfusion with incorrect type blood
  2. Hemolytic disease of the fetus/newborn - maternal IgG crosses placenta and sensitizes fetal RBCs
  3. Autoimmune hemolysis - IgG or IgM from autoimmune diseases
  4. Drug-induced autoantibodies - heparin, etc.
28
Q

What are some of the risks associated with transfusion?

A
  • Iron overload
  • Alloimmunization - developing antibodies to red blood cell membranes
  • Transfusion-transmitted infections
29
Q

What is the expected response of hemoglobin levels in an averaged-size, non-bleeding patient who undergoes a red blood cell transfusion?

A

Hemoglobin should increase by 1 g/dL (or hematocrit by 3%)

30
Q

What is the typical dosage of RBCs given to patients who undergo transfusions?

A

1 unit of red blood cells to the average-sized adult

31
Q

What is the typical dosage of RBCs in pediatric patients undergoing a transfusion?

A

5-20 mL/kg

32
Q

What are the 3 main goals of transfusion therapy for sickle cell patients?

A
  1. Improve oxygen-carrying capacity
  2. Decrease blood viscosity to improve blood flow
  3. Suppress endogenous erythropoiesis
33
Q

How do blood transfusions decrease the amount of HbS in circulation?

A

Blood transfusions decrease the level of erythropoietin made by the kidneys, decreasing the amount of HbS in circulation.

34
Q

Name the 3 types of transfusion protocols for sickle cell patients.

A
  1. Acute Simple Transfusion
  2. Chronic Transfusion
  3. Exchange Transfusion
35
Q

What is an acute simple transfusion and what is it useful for?

A

1-2 unit red cell transfusion

Helps to alleviate symptoms:

acute anemia, acute chest syndrome, aplastic crisis, sequestration

36
Q

Which type of transfusion uses apheresis to remove patient’s red cells and replace them with normal non-sickling red cells?

A

Exchange Transfusion

Used to rapidly adjust hemoglobin level and replace HbS with HbA

37
Q

What is a chronic transfusion?

A

Ongoing, planned transfusions (every few weeks) even in the absence of symptoms

Used in: recurrent stroke, frequent painful crises, complicated pregnancy

38
Q

How can frequent transfusions lead to iron overload?

A

Each RBC has 250 mg iron, but only 1 mg iron is excreted per day.

Excess RBCs get broken down and iron can’t be excreted fast enough, so it gets stored as ferritin and hemosiderin

39
Q

How does iron overload lead to organ damage?

A

Excess iron gets deposited into cells of organs as hemosiderin or ferritin. Damage to the RES, liver, heart, and spleen are all very common in iron overload.

40
Q

How is iron overload treated?

A

Chelation therapy

41
Q

What are 3 non-immune causes of patients refractory to platelet transfusion?

A
  • Splenomegaly - spleen takes up and traps excess platelets and becomes larger
  • Sepsis/fever
  • Certain Medications
42
Q

True or False: HLA or platelet-specific antibodies (HPA) are responsible for causing patients to be immune-mediated refractory to platelet transfusion?

A

True

Transfuse HLA-matched platelet products next time

43
Q

What is the name of the disease that is characterized by an incompatibility between maternal and fetal red blood cells?

A

Hemolytic Disease of the Fetus and Newborn

44
Q

What are the two defining symptoms of hemolytic disease of the newborn?

A

Hyperbillirubinemia and anemia

Excess RBC breakdown leads to anemia and an excess of bilirubin in the blood.

45
Q

How do the maternal IgG antibodies that attack fetal red cells get to the fetus from the mother’s circulation?

A

They cross through the placenta

46
Q

True or False: 60% of cases of hemolytic disease of the newborn are caused by ABO incompatibility between fetus and mother.

A

True

Most commonly: mother has type O blood (with anti-A and anti-B), but the fetus has type A or B

47
Q

What is immune-antibody hemolytic disease of the newborn and what is the most common immune antibody involved?

A

HDFN caused by immune antibodies to blood antigens other than ABO.

Most common antibody involved is anti-D

Generally affects 2nd pregnancy and beyond

48
Q

What are the 2 ways that a mother can develop immune antibodies to certain blood antigens?

A
  1. Rh negative blood, but transfused with Rh positive blood
  2. Maternal-fetal hemorrhage during a previous pregnancy

Anti-D is formed and can cross the placenta, which can then attack the fetal RBCs.

49
Q

What is erythroblastosis fetalis?

A

Prenatal presentation of HDFN characterized by anemia, high-output heart failure, edema, and polyhydramnios (hydrops fetalis)

50
Q

What are the signs and symptoms of postnatal presentation of hemolytic disease of the newborn (HDFN)?

A
  1. Anemia
  2. Hyperbilirubinemia
  3. Kernicterus - bilirubin builds up to toxic levels and gets deposited in the brain
  4. Neonatal demise due to severe neurological complications
51
Q

How does Rh Immune globulin (RhIg) prevent the development of anti-D in Rh negative mothers?

A

RhIg is an antibody to D antigen

RhIg binds D antigen on fetal cells and removes them before they can get to the mom’s cells. This prevents anti-D from forming.

52
Q

What two tests are available at delivery to assess fetal-maternal hemorrhage greater than 30 mL?

A
  1. Rosette Test - only tells you if bleed is large or small
  2. Kliehauer-Betke Test - determines how many doses of RhIg are necessary

RhIg prevents the formation of anti-D for maternal-fetal hemorrhages below 30 mL.

53
Q

If a mother tests positive for anti-D antibodies, what should be done next?

A
  1. Identify the antibody through screening
  2. Do a titer of the specific antibody (IgG or IgM)
    1. IgG can cross placenta, but IgM can’t
    2. Higher titer = more severe
  3. If IgG –> evaluate fetus with amnio or doppler
54
Q

What is the critical titer for HDFN that indicates that an amnio or other test to assess the status of the fetus should be done?

A

8 to 16 (aka Dilution of 1:8 to 1:16)

Status of fetus should be assessed if critical titer is reached

55
Q

Which specific compound in the amniotic fluid is measured via amniocentesis when HDFN is suspected?

A

Bilirubin

The more bilirubin in the amniotic fluid, the more severe the HDFN is

56
Q

You are assessing your pregnant patient for the presence of a maternal-fetal hemorrhage and find that a bleed larger than 30 mL has occurred. You order an amniocentesis and the results put the fetus in zone 1. What does zone 1 indicate about how much effect the bleed has on the fetus?

A

Zone 1 indicates a mildly affected fetus

Zone 3 indicates a severely affected fetus.

Zone 2 is questionable

57
Q

What is a middle cerebral artery peak systolic velocity (MCAPSV)?

A

A non-invasive doppler study of the MCA of the fetus. This correllates with moderate to severe fetal anemia.

Most useful between 18 and 35 weeks

58
Q

True or False: If a fetus is thought to be severely affected by HDFN, an intrauterine transfusion can be performed to increase hemoglobin.

A

True

Must know blood antigen and give anti-Kel/D, etc. with transfusion. Always use O negative blood that is irradiated.

59
Q

What are 2 management options for the postnatal period of HDFN?

A
  1. Phototherapy - fluorescent light used to breakdown bilirubin so it can be excreted
  2. Exchange transfusion - removes bilirubin, antibody-coated RBCs and maternal antibodies
60
Q

What are the indications for an exchange transfusion?

A
  1. Cord hemoglobin < 10 g/dL
  2. Rapidly rising bilirubin (>0.5 mg/dL/hour)
  3. Bilirubin > 20 mg/dL in term infant
    1. Lower in premature, hypoxia, acidosis, hypothermia

Block 8 - Autoimmunity, Neoplasia, and Hematologic Disease (20 decks)

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