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Heme / Onc > SM_256b: Blood Transfusions - Compatibility / Complications > Flashcards

SM_256b: Blood Transfusions - Compatibility / Complications Flashcards

1
Q

Blood group is ____

A

Blood group is genetically defined blood cell surface proteins or carbohydrates to which people make antibodies

  • Each blood group has its own gene or set of related genes
  • 30 RBC blood groups are defined
  • Carbohydrate blood groups: genes make the transferase enzymes which connect sugars together
  • Protein blood groups: genes make the proteins
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2
Q

Describe RBC compatibility testing

A

RBC compatibility testing

  • ABO compatability: patient and donor ABO typings
  • Rh D compatability: patient and donor D typings
  • Screen antibodies to non-ABO blood group antigens: to see if patient alloimmunized to RBC antigens from prior transfusion or pregnancy
  • Crossmatch: crossmatch with selected RBC donor unit, determine if the RBC unit is compatible with patient
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3
Q

Describe manual ABO typing

A

Manual ABO typing

  • Anti-A and anti-B
  • AB: both antisera agglutinate
  • O: neither aggultinate
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4
Q

Describe ABO blood types and antigens

A

ABO blood types and antigens

  • O: no A or B
  • A: trisaccharide
  • B: trisaccharide
  • AB: both A and B trisaccharides

Antibodies: IgM and IgG anti-A and anti-B, A or B antigens not present on self, naturally occurring beginning in infancy

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5
Q

Describe Rh D

A

Rh D

  • D- people develop anti-D when exposed to D+ RBCs: most D- pople have no Rh D protein
  • Pregnancy: D+ fetal RBCs into D- mother -> maternal anti-D can cause severe hemolysis
  • Rh Ig (passive anti-D) prevents immune anti-D after small amounts of D+ RBCs
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6
Q

In a transfusion, give ___ RBCs to D- patients

A

In a transfusion, give D- RBCs to D- patients

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7
Q

Patients can develop ____ after RBC exposure

A

Patients can develop hemolytic RBC alloantibodies after RBC exposure

  • Pregnancy or transfusion
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8
Q

Describe RBC antibody screening

A

RBC antibody screening

  • Antibody detects non-ABO RBC antibodies
  • If screen is reactive, more reagent RBCs are used to identify antibodies
  • Hemolytic (usually IgG) antibodies in 1-2% of patients
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9
Q

Describe RBC crossmatching to verify compatability of selected unit

A

RBC crossmatching to verify compatability of selected unit

  • Serological: patient has past or current hemolytic RBC antibodies, select units negative for target antigen and test patient plasma vs donor RBCs
  • Electronic: if patient does not have past or current hemolytic antibodies, type patient twice to verify and computer verification of ABO/Rh compatability
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10
Q

Direct antibody test tests RBCs directly for ____ or ____

A

Direct antibody test tests RBCs directly for IgG or C3

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11
Q

On direct antiglobulin test, IgG presence appears as ___

A

On direct antiglobulin test, IgG presence appears as warm autoantibody or transfusion reaction to transfused RBCs

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12
Q

On direct antiglobulin test, C3 presence appears as ___

A

On direct antiglobulin test, C3 presence appears as cold agglutinin and some warm autoantibodies

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13
Q

Describe RBC compatability testing terms

A

RBC compatability testing terms

  • Type and screen: patient ABO/Rh and antibody screen
    • Negative antibody screen: emergency RBCs safe
    • Positive antibody screen: identify antibody
  • Type and cross: patient ABO/Rh and antibody screen, crossmatch desired number of RBCs
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14
Q

If RBCs are medically necessary before compatability testing is done, use ___

A

If RBCs are medically necessary before compatability testing is done, use Group O RBCs

  • Rh- if girl or woman of childbearing age
  • Risk: non-ABO alloantibodies
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15
Q

Describe what to do when you get a lab specimen and when delivering blood

A

Lab specimen and when delivering blood

  • Avoid blood or labeling mixups
  • Check patient identity using wristband in hospital
  • Label all specimens immediately after collection before leaving the patient: have pre-printed labels ready but not on tubes yet
  • Blood transfusion is a time-out procedure: check correct patient and unit, two people check patient and unit at bedside, electronic bedside verification
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16
Q

Describe symptoms of a transfusion reaction

A

Transfusion reaction symptoms

  • Fever, chills, rigors
  • Hypotension, hypertension
  • Rash, itching
  • Respiratory: dyspnea, wheezing, throat swelling

Stop transfusion, maintain IV line, notify blood bank, send lab testing

If dermal allergic reaction (rash, hives, itching) notify blood bank, give anti-histamines, and restart unit carefully

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17
Q

Common transfusion reactions are ____, ____, and ____

A

Common transfusion reactions are allergic, febrile, and transfusion-associated circulatory overload

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18
Q

Describe presentation of allergic transfusion reactions

A

Allergic transfusion reactions

  • Dermal: itching, hives, rash, facial swelling
  • Airway: wheezing dyspnea
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19
Q

Allergic transfusion reactions result from ___

A

Allergic transfusion reactions result from IgE antibodies to allergens in plasma

  • Especially plasma-rich components such as plasma and platelets
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20
Q

Allergic transfusion reactions are treated with ___

A

Allergic transfusion reactions are treated with antihistamines (also prophylactic pre-transfusion)

  • Severe: epi, corticosteroids
  • Usually donor-specific, not recurrent
  • If recurrent or severe: washed RBCs or plasma-reduced platelets
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21
Q

Febrile non-hemolytic transfusion reactions present with ____, ____, or ____

A

Febrile non-hemolytic transfusion reactions present with fevers, chills, or rigors

  • Usually donor-specific, not recurrent
  • If recurrent: leukoreduced RBCs and platelets
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22
Q

Febrile non-hemolytic transfusion reactions result from ____

A

Febrile non-hemolytic transfusion reactions result from patient antibodies to donor WBCs in blood bag

  • Cytokines from donor WBCs generated during storage
  • Treat: antipyretics (acetaminophen)
23
Q

Transfusion-associated circulatory overload presents with ___, ___, ___, and ___

A

Transfusion-associated circulatory overload presents with dyspnea, hypoxia, pulmonary edema, and cardiac injury

24
Q

Transfusion-associated circulatory overload results from ___

A

Transfusion-associated circulatory overload results from RBC / plasma in tranfusion expanding the intravascular volume

  • Treat with diuresis
  • Prevent by assessing volume status pre-transfusion
25
Q

Describe serious transfusion reactions

A

Serious transfusion reactions

  • Transfusion-associated circulatory overload
  • Acute hemolytic
  • Transfusion-related acute lung injury
  • Septic
  • Anaphylactic
  • Transfusion-associated graft-vs-host disease
26
Q

Extravascular hemolysis is ____ and involves ____ and then ____

A

Extravascular hemolysis varies in speed and involves IgG antibody binding to RBC and then phagocytosis of RBC

  • IgG binds to Fc receptors on phagocytes (especially in spleen)
  • Antibody activates complement
27
Q

Intravascular hemolysis is ___ and involves ___ and then ___

A

Intravascular hemolysis is rapid and involves IgM or IgG antibody binding to RBC and then complement activation (MAC complex included)

  • MAC forms a pore
28
Q

Describe presentation of acute hemolytic reactions

A

Acute hemolytic reactions

  • Fevers / chills
  • Hypotension / shock
  • Dark urine / renal insufficiency
  • Bleeding and prolonged PT / PTT
29
Q

Acute hemolytic reaction pathogenesis involves ____

A

Acute hemolytic reaction pathogenesis involves intravascular RBC lysis

  • Free RBC membranes with antibody activate inflammation
  • Damage renal tubules -> acute tubular necrosis
  • Activate clotting cascade -> DIC
30
Q

Acute hemolytic reaction results from ____

A

Acute hemolytic reaction results from incorrect blood specimen (wrong patient / blood type)

  • Mistransfusion to wrong patient
  • Antibody to RBC unit undetected in screen / crossmatch
31
Q

Acute hemolytic reaction tests involve ____, ____, and ____

A

Acute hemolytic reaction tests involve direct antiglobulin test, repeat compatability testing, and urinalysis for hemoglobinuria

32
Q

Acute hemolytic reaction treatment involves ____

A

Acute hemolytic reaction treatment involves diuresis to protect vs acute tubular necrosis

  • Plasma / platelets if needed for bleeding / coagulopathy
  • Blood pressure support is needed
33
Q

Transfusion-related acute lung injury presents with ___, ___, ___, and ___

A

Transfusion-related acute lung injury presents with dyspnea, hypoxia, often fever, and diffuse pulmonary edema ≤ 6 hours after transfusion

34
Q

Transfusion-related acute lung injury results from ____

A

Transfusion-related acute lung injury results from donor plasma antibodies to patient WBCs

  • Activated WBCs damage pulmonary capillaries
  • Donors often multiparous women, pregnancy-induced antibodies
35
Q

Describe treatment, testing, and preveention for transfusion-related acute lung injury

A

Treatment, testing, and preveention for transfusion-related acute lung injury

  • Treat: respiratory support
  • Test: involved donors tested for anti-HLA and anti-neutrophil antibodies
  • Prevent: make plasma from male donors, test parous women platelet donors for HLA antibodies, and defer transfusion-related acute lung injury donors
36
Q

Septic reaction to transfusion presents with ____, ____, ____, ____, and ____

A

Septic reaction to transfusion presents with fevers, chills, rigor, hypotension, and shock

37
Q

Septic reaction to transfusion presents results from ___

A

Septic reaction to transfusion presents results from bacteria in blood bag (especially platelets)

38
Q

Describe testing, treatment, and prevention of septic reactions to transfusion

A

Septic reactions to transfusion

  • Test: Gram stain and culture residual blood bag contents
  • Treat: broad-spectrum antibiotics guided by testing
  • Prevent: donor health screening (antiseptic blood collection, bacterial testing / culture of all platelets)
39
Q

Anaphylactic reaction to transfusion presents with ____, ____, ____, and ____

A

Anaphylactic reaction to transfusion presents with hypotension, shock, airway edema, and obstruction

40
Q

Anaphylactic reaction to transfusion results from ____

A

Anaphylactic reaction to transfusion results from recipient IgE antibodies to plasma allergens

  • IgA deficient patient can present with anti-IgA antibodies
41
Q

Describe testing, treatment, and prevention of anaphylactic reactions to transfusion

A

Anaphylactic reactions to transfusion

  • Test: IgA level, anti-IgA antibodies
  • Treat: antihistamines, epinephrine, corticosteroids
  • Prevent: wash RBCs and platelets for IgA deficient patients
42
Q

Transfusion associated graft vs host disease presents with ____, ____, ____, ____, and ____

A

Transfusion associated graft vs host disease presents with rash, fever, diarrhea, hepatitis, and pancytopenia 3-30 days post-transfusion

  • Cellular immune reaction, donor lymphocytes vs organs
43
Q

Transfusion associated graft vs host disease results from ___

A

Transfusion associated graft vs host disease results from lack of normal rejection of transfused RBCs

  • Severe immunosuppression
  • Closely HLA-matched donor such as blood relative
44
Q

Describe testing, treatment, and prevention of transfusion associated graft vs host disease

A

Transfusion associated graft vs host disease

  • Test: chimerism studies of blood or tissues
  • Treat: immunosuppression of graft vs host disease reaction
  • Prevent: gamma irradiation to RBCs / platelets for susceptible patients
45
Q

Transfusion associated graft vs host disease resuls because ___

A

Transfusion associated graft vs host disease resuls because donor WBCs see recipients’ other antigens as foreign

46
Q

Describe RBC alloimmunization

A

RBC alloimmunization

  • Transfusion or pregnancy exposure
  • Delayed hemolytic transfusion reaction
    • Destruction of transfused RBCs days after transfusion
    • Restimulation of RBC antibodies after prior immunization
    • RBC antibodies can disappear over time then are not detected in compatability testing
    • Kidd (Jk) blood group antibodies are the most common causes
47
Q

Describe HLA alloimmunization

A

HLA alloimmunization

  • Anti-HLA antibodies, transfusion, pregnancy
  • Febrile transfusion reactions
  • Platelet refractoriness: HLA antigens on transfused platelets
  • Organ or stem cell transplant graft rejection
  • Give leukoreduced RBCs/platelets if recurrent febrile reactions, need for recurring platelet transfusions, or organ / stem cell transplant patients / candidates
48
Q

Describe donor screening

A

Donor screening

49
Q

Describe current risk infection estimates from transfusion

A

Current risk infection estimates from transfusion

  • HIV: 1 in 1.5 million units
  • Hepatitis C: 1 in 1.1 million units
  • Hepatitis B virus: 1 in 1.0 million

HBV is most common but all are rare

50
Q

____, ____, ____, and ____ can also be transmitted during transfusion

A

Zika virus, cytomegalovirus, babesios, and Creutzfeldt-Jakob disease can also be transmitted during transfusion

  • Cytomegalovirus: mainly in WBCs
  • Babesiosis: RBC parasite
51
Q

Describe pathogen reduction technologies for transfusions

A

Pathogen reduction technologies for transfusions

  • Solvent-detergent (pooled plasma): disrupts RBCs
  • Psoralen-UV light (plasma and platelet units): UV does not penetrate RBC units
  • Riboflavin-UV light (plasma and platelet units): nucleic acid damage
  • Methylene blue-visible light (plasma units): nucleic acid damage
52
Q

Solvent-detergent ___ disrupt non-enveloped viruses such as Hepatitis A and parvovirus

A

Solvent-detergent does NOT disrupt non-enveloped viruses such as Hepatitis A and parvovirus

53
Q

Psoralen binds to ___, while UV light induces ___, leading to inactivation of microbes

A

Psoralen binds to nucleic acid, while UV light induces crosslinking, leading to inactivation of microbes

  • Also prevents graft vs host disease by inactivating donor WBCs

Heme / Onc (41 decks)

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