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Blood Bank Test 4 > Study Guide Information > Flashcards

Study Guide Information Flashcards

1
Q

A transfusion reaction is

A

a physical reaction to the transfer of blood components

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2
Q

An immediate hemolytic reaction is characterized by…
Cause
Symptoms
Prevention

A

Transfer of RBC/Whole Blood (anti-A, Kell, Jka, Fya)
Intravascular; fever, oliguria, anuria, death, nasea, back or chest pain, vomiting
Follow procedures

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3
Q

A delayed hemolytic transfusion reaction is characterized by
Cause
Symptoms
Prevention

A

Secondary response to transfused RBCs
Fever, chills, mild jaundice
Document medical history/transfusions, pregnancy, transplants

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4
Q

TRALI
Cause
Symptoms
Prevention

A

Transfusions of pre-formed donor HLA antibody into a patient that causes respiratory compromise within 6 hours
Respiratory distress, acute pulmonary edema, hypotension, fever, “White Out”
Possibility of deferring multiparous women from future donations

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5
Q

TACO
Cause
Symptoms
Prevention

A

Infusion of fluid volume behind capacity of an individual’s cardiovascular system.
Shortness of breath, coughing, decreased O2 sat, wheeing, cyanosis, elevated BP, decreased pulse, peripheral edema. Chest X-ray may show bilateral lung infiltrates and sometimes heart enlargement.
Slow transfusion rate (TX= 100mL/hr); aliquot blood

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6
Q

Febrile Reaction
Cause
Symptoms

A

Antileukocytic antibodies in plasma

1 degree rise in temperature associated with transfusion and having no medical explanation other than transfusion

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7
Q

Anaphylactic or Anaphylactoid Reaction
Cause
Symptoms
Prevention

A

Anti-IgA in plasma occuring after transfusion of only few mL of plasma (or plasma components)
Coughing, breathing trouble, hives, chest pain, shock, death
Total plasma removal

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8
Q

Allergic Reaction
Cause
Symptoms
Prevention

A

Allergen complexes (histamine release)
Redness, itching, and hives
Pre-medicate with Benadryl

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9
Q

Bacterial Contamination
Cause
Symptoms
Prevention

A

Endotoxins produced by bacteria capable of growing in cold (E. coli, Staphylococcus, and Yersinia)
“Warm” reaction, dryness, flushing of skin
Strict protocol, transfer within time limit, now culture platelets to ensure safer product

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10
Q

Transfusion-Associated Graft-vs-Host
Cause
Symptoms
Prevention

A

Attack from donor T-cell lymphocytes against the patient, and recipient becomes foreigner
Rash, fever, nausea, vomiting, or diarrhea days to weeks following transfusion (CBC reveals pancytopenia, with liver enzymes abnormal)
Irradiation of blood products, especially of family members, neonates, and transplant patients, to inactivate leukocytes.

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11
Q

Posttransfusion Purpura
Cause
Symptoms
Prevention

A

Pre-formed platelet-specific alloantibodies present in patients plasma that were induced from prior transfusion, pregnancy, or tissue exposure (PLA-A)
Sudden onset of red to purple discolorations on the skin the size of pencil eraser
HLA negative platelets in future

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12
Q

Alloimmunization to HLA Antigens
Causes
Symptoms
Prevention

A

Formation of HLA antibodies following exposure to antigens from transfusion, pregnancies, or tansplants. Common in multiparous women
Platelets refractoriness- no increase in counts following transfusion of platelets
Irradiated HLA matched platelets and ABO-matched leukoreduced platelets

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13
Q

Hypothemia

A

Significant decrease in core body temperature due to low temperature of blood products (stored in cold 1-6 degrees). Can lead to heart failure, respiratory distress, neurological disturbances. Use blood warmer to warm blood.

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14
Q

Potassium Abnormalities

A

Extracellular K concentrations narrow range of 3.5-5.5 mEq/L to prevent cardiac failure. During storage of RBC units, some intracellular K leaks into small extracellular volume. May send patient into hyperkalemia.

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15
Q

Transfusion-related Immunomodulation

A

Patients who have been transfused have been exposed to more HLA antigens and have better acceptance of transplants. Some research shows increase risk of infection, malignancy, short-term mortality.

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16
Q

Transfusion-associated Hemosiderosis (Iron Overload)

A

Long term complication of RBC transfusions to those with chronic anemia; deposition of iron in tissue and organs.
Unit of RBC=250mg of iron (4 units=1gram)

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17
Q

Air Embolism

A

Equipment malfunction or improper setup of insuion set or perioperative blood recovery. Infusion of as little as 100mL of air within intravasular space can be fatal.
Cough, difficulty breathing, choking, death.

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18
Q

Pathophysiology of Transfusion-Induced Hemosiderosis (Iron Overload)

A

Accumulation of iron affects the function of heart, liver, and endocrine glands.
Patients at risk: beta-thalassemia major, congenital hemolytic anemia, or aplastic anemias.

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19
Q

What antibodies are usually the cause of Immediate Hemolytic Reactions?

A

anti-A
anti-Kell
anti-Jka
anti-Fya

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20
Q

Immediate hemoytic reactions are intra/extra vascular?

A

Intravascular

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21
Q

What three reactions are considered to be DELAYED NON-HEMOLYTIC reactions?

A

Post-transfusion purpura
TX-associated graft vs. host
Iron Overload

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22
Q

Hepatitis

Vaccine?

A

Hep B

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23
Q

Hepatitis

Bloodborne

A

Hep B, C, D

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24
Q

Hepatitis

Fecal-Oral

A

Hep A, E

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25
Q

Hepatitis

Chronic States

A

Hep B, C, D

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26
Q

Hepatitis

Carrier States

A

Hep B, C, D

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27
Q 
Hepatitis
Long Incubation (how long?)
A

Hep B: 4-150 days

Hep C: 20-90 days

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28
Q

Describe the Procedure for a Transfusion Workup

A
  1. Check for discrepancies in patient/donor ID (label and record checks)
  2. Observe patient’s pre- and post- transfusion samples and donor segments
  3. DAT on post transfusion sample
  4. ABO/Rh typing on patient’s pre- and post- transfusion samples and donor segments
  5. Compatibility test on patients pre- and post- transfer samples with donor segments
  6. Antibody screen and antibody ID on patients pre- and post- transfer samples and donor segments
  7. Test urine for free Hgb
  8. Bilirubin test
  9. Hgb and Hct levels
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29
Q

Which fluids has HIV been isolated from?

A 
Blood
Semen
Vaginal secretions
Tears
Sweat
Breast Milk
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30
Q

Which individuals are at risk for HIV?

A 
Homosexuals/ bisexuals
IV drug users/prostitutes
Transfusion recipients
Health care workers
Infants born to infected mothers
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31
Q

Define kernicterus

A

Toxic levels of bilirubin in a newborn’s brain that causes permanent brain damage

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32
Q

Review HDNF Process

A

HDNF

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33
Q

Describe the EXPOSURE factors of HDNF which affect severity?

A

Transplacental hemorrhage of fetal RBC into maternal circulation (7% of pregnancies)
Amniocentesis, chroionic villus sampling, trauma to abdomen
0.1mL of fetal RBC can stimulate immune response in mother

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34
Q

Describe HOST FACTORS of HDNF which affect severity?

A

Depends on complex genetic factors
In Rh-neg individuals, transfused with one unit of Rh+ blood, about 80% will form anti-D
Rh-negative mother after and Rh+ pregnancy= 10% will form anti-D

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35
Q

In an Rh-neg mother after an Rh-pos pregnancy, how many will form anti-D?

A

10%

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36
Q

How many mL of feteal RBCs can stimulate an immune response in mother?

A

0.1mL

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37
Q

Describe IMMUNOGLOBULIN CLASS of HDNF which affect severity?

A 
IgG crosses the placenta
Subclass IgG1 and IgG3 are most efficient at crossing the placenta
Subclasses in mother affect severity of HDNF
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38
Q

Describe ANTIBODY SPECIFICITY of HDNF which affect severity?

A

Rh (D) is the most immunogenic
C, E, and c are also potent immunogens (moderate to sever HDNF)
After Rh, anti-Kell is most clinically significant

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39
Q

What is erythroblastosis fetalis?

A

Destruction of fetal RBCs stimulates anemia and in turn erythroblasts are released into fetal cirulation

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40
Q

What is hydrops fetalis?

A

Sever anemia in the fetus. Cardiac failure, edema, effusions and ascites which may develop at 18 to 20 weeks. Used to be fatal but may now be treated.

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41
Q

What is kernicterus?

A

Bilirubin induced brain damage.

42
Q

At what level does bilirubin cause fetal brain damage?

A

18 mg/dL

43
Q

When do mothers undergo ABO/Rh typing and antibody screen, and medical history?

A

First trimester, first visit

44
Q

If a mother has an antibody detected during her antibody screen, who should be tested?

A

The fathers blood should be tested for the corresponding antigen.

45
Q

What can be done to test for fetal antigens?

A

Amniocentesis

46
Q

When testing an antibody titer, what value is considered signifiacnt?

A

Titer of 32

47
Q

At 18 to 20 weeks gestation, a second titer should be drawn to look for

A

Increased antibody production

48
Q

What procedure can be used to monitor the concentration of bilirubin pigment in amniotic fluid?

A

Amniocentesis

49
Q

How is HDNF managed?

A
  1. Intrauterine transfusion
  2. Early delivery
  3. Phototherapy with UV light
  4. Transfusion of newborn
50
Q

What is the formula for RhoIG administration?

A

(# fetal cells/# adult cells) x 5000
Divide this number by 30
= Number of vials

51
Q

Define Hemolytic Disease of the Newborn and Fetus

A

Pathologic condition resulting from attachment of an IgG maternal antibody to cells of the fetus that contain the antigen to which the maternal antibody is directed. The antigen is inherited from the father and absent from the mother.

52
Q

What is a fetal-maternal hemorrhage?

A

The passage of RBCs from the FETUS to the MOTHERS circulation as a result og placental transfer, or at delivery.

53
Q

Define extramedullary erythropoiesis

A

Production of red cells outside the bone marrow.

54
Q

Define Antipartum

A

Before delivery

55
Q

Define Kernicterus

A

Buildup of unconjugated bilirubin in neural tissues of an infant with sever HDNF that can result in irreversible damage if not treated quickly enough. Usually during first 2 to 8 days of life, can cause permanent brain damage if over > 18md/dL

56
Q

Define hydrops fetalis

A

Clinical condition in infants characterized by cardiac insufficiency with resultant edema and respiratory distress.

57
Q

Define Erythroblastosis fetalis

A

Hemolytic Disease associated with anemia, jaundice, spleenomegaly, edeme, and the prescence of immature RBCs in circulation. Another name for HDNF

58
Q

Who discovered HDNF

A

Levine and Stetson

59
Q

What are the 3 types of HDNF?

A

ABO
Rh
alloantibodies

60
Q

How early can D antigens form on fetal RBCs?

A

38 days

61
Q

What amount of D+ fetal cells can cause immunization in mother?

A

0.1mL

62
Q 
Immunization Rate of D-neg Mothers with D+ babies
\_\_% first preganancy
\_\_% at delivery
\_\_% 6 months
\_\_% next preganancy
A

16% first preganacy
1.5-2% at delivery
7% 6 months
7$ by next pregnancy

63
Q

Which subclasses of IgG are most efficieny at crossing the placenta?

A

IgG1

IgG3

64
Q

When does active transport of IgG begin in pregnancy?

A

The second trimester (continues until birth)

65
Q

What reaction grade does Judd recommend in case of D mosaic?

A

2+

66
Q

At how many weeks is a second antibody test repeated on mom?

A

28 weeks

67
Q

How can you determine IgG from IgM antibodies?

A

DTT

2-ME

68
Q

If a mother has a positive antibody, at 18 to 20 weeks a second titer should be performed to

A

look for increased antibody production

69
Q

What factors can affect titers?

A

Choice of cells
Media used
Time and temp
Technical Issues

70
Q

Define critical titer

A

Established by the lab; the number under which no severly affected infants or stillbirths have been reported (most use 32, anti-K may be as low as 8)

71
Q

This technique can be used to determine bilirubin levels and fetal lung maturity.

A

Amniocentesis

72
Q

How is bilirubin measured in amniotic fluid?

A

Amnicentesis
Pigment is scanned with spectrophotometer (at 450 nm)
Platted on Liley graph

73
Q

Factors affecting amniotic fluid analysis

A 
Turbidity
Blood
Meconium
Light
Dilution
Other fluids
Multiple sacs
74
Q

Define Chorionic villi

A

a branching, vascular process of the embryonic membrane forming part of the placenta

75
Q

What is Chorionic cilli sampling?

A

A biopsy of the chorion frondosum through the abdominal wall or through the endocervical canal at 6-12 weeks gestation to obtain fetal cells for diagnosis of chromosomal abnormalitites. Higher rate of spontaneous abortion.

76
Q

Define PUBS

A

Cordocentesis- Percutaneous Umbilical Blood Sampling

Method for obtaining fetal blood sample (Can perform ABO, Rh, other antigens, Hgb, Hct, and DAT)

77
Q

How can you confirm a PUBS blood sample is fetal?

A

Mix water and NaOH
pink if fetal
yellow-brown adult

78
Q

PCR can find

A

Fetal DNA in maternal plasma (RHD gene)
Must run controls of mom and dad in paralel
Not all cases have fetal DNA present in maternal bloodstream

79
Q

When is an Intauterine Transfusion performed?

A

When the amniotic fluid results for bilirubin are in Zone II or III
Cordocentesis blood sample has Hgb < 10g/dL
Fetal hydrops is noted on ultrasound

80
Q

An intrauterine transfer into the fetal peritoneal cavity

A

Intraperitoneal

81
Q

An intrauterine transfer into fetal umbilical vein

A

Intravascualar

82
Q

Donor blood for an intrauterine transfer should be

A 
Fresh
Antigen neg
O neg
CMV neg/ leukocyte resuced
Irradiated
Washed
Sickledex neg
AHG crossmatched
Not from father of fathers family
83
Q

IUT calculation

A

(gestational age in weeks - 20) x 10mL

Target Hct of 40-50%

84
Q

How much does the Hct of a fetus that recieved an IUT drop per day?

A

1% per day

85
Q

How is fetal lung maturity measured?

A

L/S ratio (2 phospholipid sufactants in amniotic fluid)

> 2.0 good predictor

86
Q

What contaminates cord blood?

A

Wharton’s Jelly

Remove by washing RBCs 4-6 times with saline

87
Q

ABO HDNF is usually treated

A

by photo therapy only

88
Q

What ratio of preganacies are ABO incompatible?

A

1 in 5

89
Q

While caucasian infants with group A or B are at risk for HDNF, African American infants at risk are

A

Mostly only group B

2-6 times more common than in caucasians

90
Q

Define and exchange transfusion

A

Used in premature infants

Remove 80-90% of RBCs and 25-35% of bilirubin and replace with donor cells

91
Q

Define small aliquot transfusion

A

Used to correct fetal anemia when exchange transfusion is not warrented

92
Q

How does RhoIg work to prevent HDNF?

A

RHoIg attached to Rh+ fetal cells in the maternal circulation
Sensitized cells are then trapped in the maternal spleen and destroyed, thus preventing exposure

93
Q

How much RhoIg (micrograms) should be given per packed/whole blood (mL)

A

300 micrograms

15mL of packed RBCs
or
30mL of whole blood

94
Q

A microdose of RhoIg is given to women after

A

Abortion
Amniocentesis
Ectopic rupture

95
Q

Define the Screening Rosette Test

A

Rh+ fetal cells coated with anti-D form rosettes with Rh+ indicator cells, making them distinguishable microscopically from Rh- maternal cells.
30mL fetal cells= positive

MUST confirm with Kleihauer-Betke is positive

96
Q

Define the Quantitative Kleihauer-Betke test

A

A maternal blood stain is prepared in order to count the amount of fetal cells present. The fetal cells stain bright red/pink in acid and the maternal cells will appear as ghosts. After 2000 cells are counted, the % of fetal cells is determined.

97
Q

What are other caused of HDNF and Similar diseases?

A

Maternal Warm Autoimmune Hemolytic Anemia
Maternal Alloimmunization to Platelets
Maternal Autoimmune Thrombocytopenia

98
Q

Define Maternal Warm Autoimmune Hemolytic Anemia

A

IgG crosses the placenta and can affect fetus

99
Q

Define Maternal Alloimmunization to Platelets

A

PLA1 (HPA-1) platelet antigen. Occurs when mother is negative and fetus is positive. Apherese mom and transfuse PLA1 platelets to baby.
Treatment is IVIG
Goal is 50,000/uL platelet count at delivery (20,000 after birth)

100
Q

Define Maternal Autoimmune Thrombocytopenia

A

Autoantibodies cross the placenta and affects fetal platelets. IVIG and steroids are given to mom. C-section delivery is common. Infant recovers in 2-3 weeks as antibodies dissaper.

101
Q

Other causes of fetal or newborn hemolysis, associated anemia, hydrops, or jaundice

A

Genetic red cell membrane or enzyme defect
Acquired defect of red cells to secondary infections (rubella, CMV, parvovirus)
Prematurity and physiologic haundice due to insufficient production of glucoronyl transferases

Blood Bank Test 4 (2 decks)

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