random facts about transfusion medicine- Martin Flashcards
what diseases will result in an altered A Ag
leukemia = dec Ag on each RBC
gastric/pancreatic carcinoma= increased serum BGSS–> neutralize any Anti-A Ab –>makes the blood look like “O type” on forward and backward testing
intestinal obstructions: acquired B Ag on previously A cells
–> forward typing shows AB, back typing shows only anti-B Ab
forward vs backwards typing of ABO
forward: put commerical anti-sera Ab into pt’s RBC –> will it bind pt?
bach/reverse: add pts sera into type of known At (A/B/anti-D) –> will pt attack?
is Rh Ab naturally occurring
no
McLeod Phenotype
abn Kell Ag –> acanthocytes (spur cell) with chronic compensated hemolytic anemia
chronic granulomatous ds of childhood (x NADH-oxidase on Nø)
Kell vs Kidd vs Duffy vs MNS vs Lewis systems
Kells= K and k Ags= IgG
–> HDN +hemolytic transfusion rxn
Kidd= Jk(a) and jk(b)
NO Ab detected bc its so transient and weak binding, but then causes rapid hemolysis post transfusion
dosage phenomenon= stronger rxn to homozygous cells
Duffy: Fya and Fyb
IgG Ab, cause HDN and hemolytic transfusion rxn
Fy(a-,b-) seen in AA, resistance to P. xivax
MNS system: M, N, S, s
anti-M IgM, NON HEMOLYTIC usually
dosage phenomenon
Lewis system
IgM warm Abs, naturally occuring
Le Ag –> lewis lives
shelf life of RBC
plts
plasma
RBC= 42 days plt= 5 days plasma= 1 yr frozen
antibody screen, direct vs indirect Coomb’s test
DAT= detect autoimmune hemolytic anemia
pt’s washed RBCs incubated w Ab against self Af
use RBCs
IAT= for pretransfusion ad pre-natal preg tests
recipient Ig target donor Ab= complex
use serum
bombay phenotype is what
Oh/ h/h phenotype
no H, anti-H Ab need transfusion with another of the same phenotype
given autoimmune hermolytiv anemia, which type is most problematic for Ab screening
cold can give a false (+) ABO, but if you just warm up the serum you can avoid it
oft= auto-anti-I
warm= more problematic for Rh, Kell, Kidd, Duff, no affect ABO
what infections are associated with causing cold agglutinin ds
mycoplasma pnuemoniae infectious mono (EBV)
steps of IAT
- room temp = detect cold IgM
- 37C= detect warm Ab= IgG, Rh, Kell, Kidd, Duffy
- AHG= detect warm, IgG that coat RBC
- CC: verify the AHG findigns
acute hemolytic transfusion reaction
etiology
sx
trx
prevention
preformed IgM Ab, induce complement and intravasc hemolysis
sx= HYPOtension, Hgb-emia+uria, DIC, flank pain, dyspnea, fever, –>late=renal failure
trx= discontinue and verify
Na-bicard to maintain pH
prevent: proper ID pt
delayed hemolytic transfusion reaction
etiology
sx
trx
prevention
> 24 hrs post, = IgG
(DAT), common causes= Rh, Kell, Kidd
extravasc hemolysis
labs= inc LDH+bili, dec haptoglobin
trx= IVIG, prevent renal/sickle crisis w fluids
prevention: serologic detection of RBC Ab is key!! (abo, etc)
febrile hemolytic transfusion reaction
etiology
sx
trx
prevention
MOST COMMON RXN
can be delayed up to an hour post transfusion
sx= fever, chills, HYPERtension,
trx= r/u lifethreatning ds, fever self resolve in 2-3 hrs
antipyretic (acetominophen), meperidine
NO ASA
p: prophylactic antipyretic, pre-storage leukocytes and plasma reduction
allergic urticarial transfusion reaction
etiology
sx
trx
prevention
recipient IgE against donor Ag
in IgA deficient recipeint= anti-IgA IgGs
can look like TRALI if have dyspnea = pruritis, urticaria, cut flushing, laryngeal edema and bronchoconstrictions (wheeze, CP)
trx: antihistamine (diphenhydramine)
intubate, O2 prn
p: check for IgA deficiency, prophylactic antihistamine
severe allergic (anaphylactic) transfusion reaction
sx
trx
prevention
sx= CV instbaility, HYPOtension, tachy, LOC, arrhythmia/cardiac arrest
trx= intubate, O2 prn,
IV diphenhydramine + epinephrine
aminophylline for bronchospasms
p: check for IgA deficiency, prophylactic antihistamine
TRALI transfusion reaction
etiology
sx
trx
prevention
= w/in hours, Ab bind MHC 1 Ag on Nøs (2 hit hypothesis)
associated w multiparous Fs
w transfusion of FFP and pls
sx= NONCARDIOGENINC PULM EDEMA- dyspnea, hypoxia, tachy, fever and HYPOtension, normal breath sounds
dx w n level of pulm A wedge P
trx= self-resolve within 48-96 hrs- support w antipyretics, lfuids, O2…
infection associated w transfusion reaction
etiology
sx
trx
prevention
associated with transfusion of platelets and plasma cell
most common = skin flora from the donor, contaminated unit
Septic bacteria infections:
Yersinia enterocoitica, pseudomonas ~ packed RBC
strep+staph, salmonella, Escherichia, serratia
~ plts
less common are viral infections
HIV, HepC+B mostly
indications and expected results of transfusion w packed RBC
contra?
storage?
i: symptomatic anemia
e: Hgb inc ~1 for every unit in 24 hrs
inc Hct 3% per unit in 24 hrs
contra= volume expansion, coag deficiency, drug treatable anemia
35-42 days storage
indications and storage of transfusion w frozen/deglyced RBC
i: hypersensitivity to plasma particles
store for 10 yrs, 24 hrs post thawing
indications and storage of transfusion w washed RBCs
i: severe allergic rxn to unwashed RBCs
storage: 24 hrs
indications and storage of transfusion w irradiated RBC
i: risk of GVHD
storage: 35-42 days
indications and storage of transfusion w leukocyte reduced RBCs
i: febrile rxns secondary to leukocyte Ab
store: 35-42 days
the minimum threshold of plts in @ risk populations: keep plts above this number
in pts w no bleeding, just prophylactic
in pts w sign hemorrhage
in pts w risk of CNS bleeding
in pts w no bleeding, just prophylactic 10k in pts w sign hemorrhage 50k in pts w risk of CNS bleeding 100k
do you need to check compatibility if you are only transfusing platelets
yes still need ABO, may be need to get Rh (risk of RBC contamination)
indications and storage of transfusion w fresh frozen plasma
indicated in pts w
- deficit of coag factors
- emergent warfarin reversal needed
- trx TTP
storage: 18c for 1 yr
indications and storage of transfusion w cryoprecipitate
provides fibrinogen in the setting of F8/vWF replacement needed
storage: 18c for 1 yr
RhoGAM
what is the Kleihauer Betke test:
when do you give RhoGAM
kleihauer betke test: measure fetal Hbg in mom’s circulation
give on dose at 26-28 wks gestation OR w/on 72 hrs of delivery of Rh+ infant
when giving massive transfusions, what is the rule of thumb of the amount of units you are giving
give 1 unit FFp per every 2-3 units of RBCs
indication for the following types of apheresis trxs
plasma exchange
therapeutic plasmapharesis
therapeutic RBC exchange
autologous
plasma exchange
TTP + HUS
therapeutic plasmapharesis
hematologic / neuro ds
therapeutic RBC exchange
sickle cell crisis prevention, HDN
autologous
save own components for use in a crisis
