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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
Hepatitis | Chronic States
Hep B, C, D
26
Hepatitis | Carrier States
Hep B, C, D
27
``` Hepatitis Long Incubation (how long?) ```
Hep B: 4-150 days | Hep C: 20-90 days
28
Describe the Procedure for a Transfusion Workup
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
29
Which fluids has HIV been isolated from?
``` Blood Semen Vaginal secretions Tears Sweat Breast Milk ```
30
Which individuals are at risk for HIV?
``` Homosexuals/ bisexuals IV drug users/prostitutes Transfusion recipients Health care workers Infants born to infected mothers ```
31
Define kernicterus
Toxic levels of bilirubin in a newborn's brain that causes permanent brain damage
32
Review HDNF Process
HDNF
33
Describe the EXPOSURE factors of HDNF which affect severity?
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
34
Describe HOST FACTORS of HDNF which affect severity?
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
35
In an Rh-neg mother after an Rh-pos pregnancy, how many will form anti-D?
10%
36
How many mL of feteal RBCs can stimulate an immune response in mother?
0.1mL
37
Describe IMMUNOGLOBULIN CLASS of HDNF which affect severity?
``` IgG crosses the placenta Subclass IgG1 and IgG3 are most efficient at crossing the placenta Subclasses in mother affect severity of HDNF ```
38
Describe ANTIBODY SPECIFICITY of HDNF which affect severity?
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
39
What is erythroblastosis fetalis?
Destruction of fetal RBCs stimulates anemia and in turn erythroblasts are released into fetal cirulation
40
What is hydrops fetalis?
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.
41
What is kernicterus?
Bilirubin induced brain damage.
42
At what level does bilirubin cause fetal brain damage?
18 mg/dL
43
When do mothers undergo ABO/Rh typing and antibody screen, and medical history?
First trimester, first visit
44
If a mother has an antibody detected during her antibody screen, who should be tested?
The fathers blood should be tested for the corresponding antigen.
45
What can be done to test for fetal antigens?
Amniocentesis
46
When testing an antibody titer, what value is considered signifiacnt?
Titer of 32
47
At 18 to 20 weeks gestation, a second titer should be drawn to look for
Increased antibody production
48
What procedure can be used to monitor the concentration of bilirubin pigment in amniotic fluid?
Amniocentesis
49
How is HDNF managed?
1. Intrauterine transfusion 2. Early delivery 3. Phototherapy with UV light 4. Transfusion of newborn
50
What is the formula for RhoIG administration?
(# fetal cells/# adult cells) x 5000 Divide this number by 30 = Number of vials
51
Define Hemolytic Disease of the Newborn and Fetus
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
What is a fetal-maternal hemorrhage?
The passage of RBCs from the FETUS to the MOTHERS circulation as a result og placental transfer, or at delivery.
53
Define extramedullary erythropoiesis
Production of red cells outside the bone marrow.
54
Define Antipartum
Before delivery
55
Define Kernicterus
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
Define hydrops fetalis
Clinical condition in infants characterized by cardiac insufficiency with resultant edema and respiratory distress.
57
Define Erythroblastosis fetalis
Hemolytic Disease associated with anemia, jaundice, spleenomegaly, edeme, and the prescence of immature RBCs in circulation. Another name for HDNF
58
Who discovered HDNF
Levine and Stetson
59
What are the 3 types of HDNF?
ABO Rh alloantibodies
60
How early can D antigens form on fetal RBCs?
38 days
61
What amount of D+ fetal cells can cause immunization in mother?
0.1mL
62
``` Immunization Rate of D-neg Mothers with D+ babies __% first preganancy __% at delivery __% 6 months __% next preganancy ```
16% first preganacy 1.5-2% at delivery 7% 6 months 7$ by next pregnancy
63
Which subclasses of IgG are most efficieny at crossing the placenta?
IgG1 | IgG3
64
When does active transport of IgG begin in pregnancy?
The second trimester (continues until birth)
65
What reaction grade does Judd recommend in case of D mosaic?
2+
66
At how many weeks is a second antibody test repeated on mom?
28 weeks
67
How can you determine IgG from IgM antibodies?
DTT | 2-ME
68
If a mother has a positive antibody, at 18 to 20 weeks a second titer should be performed to
look for increased antibody production
69
What factors can affect titers?
Choice of cells Media used Time and temp Technical Issues
70
Define critical titer
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
This technique can be used to determine bilirubin levels and fetal lung maturity.
Amniocentesis
72
How is bilirubin measured in amniotic fluid?
Amnicentesis Pigment is scanned with spectrophotometer (at 450 nm) Platted on Liley graph
73
Factors affecting amniotic fluid analysis
``` Turbidity Blood Meconium Light Dilution Other fluids Multiple sacs ```
74
Define Chorionic villi
a branching, vascular process of the embryonic membrane forming part of the placenta
75
What is Chorionic cilli sampling?
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
Define PUBS
Cordocentesis- Percutaneous Umbilical Blood Sampling | Method for obtaining fetal blood sample (Can perform ABO, Rh, other antigens, Hgb, Hct, and DAT)
77
How can you confirm a PUBS blood sample is fetal?
Mix water and NaOH pink if fetal yellow-brown adult
78
PCR can find
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
When is an Intauterine Transfusion performed?
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
An intrauterine transfer into the fetal peritoneal cavity
Intraperitoneal
81
An intrauterine transfer into fetal umbilical vein
Intravascualar
82
Donor blood for an intrauterine transfer should be
``` Fresh Antigen neg O neg CMV neg/ leukocyte resuced Irradiated Washed Sickledex neg AHG crossmatched Not from father of fathers family ```
83
IUT calculation
(gestational age in weeks - 20) x 10mL | Target Hct of 40-50%
84
How much does the Hct of a fetus that recieved an IUT drop per day?
1% per day
85
How is fetal lung maturity measured?
L/S ratio (2 phospholipid sufactants in amniotic fluid) | > 2.0 good predictor
86
What contaminates cord blood?
Wharton's Jelly | Remove by washing RBCs 4-6 times with saline
87
ABO HDNF is usually treated
by photo therapy only
88
What ratio of preganacies are ABO incompatible?
1 in 5
89
While caucasian infants with group A or B are at risk for HDNF, African American infants at risk are
Mostly only group B | 2-6 times more common than in caucasians
90
Define and exchange transfusion
Used in premature infants | Remove 80-90% of RBCs and 25-35% of bilirubin and replace with donor cells
91
Define small aliquot transfusion
Used to correct fetal anemia when exchange transfusion is not warrented
92
How does RhoIg work to prevent HDNF?
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
How much RhoIg (micrograms) should be given per packed/whole blood (mL)
300 micrograms 15mL of packed RBCs or 30mL of whole blood
94
A microdose of RhoIg is given to women after
Abortion Amniocentesis Ectopic rupture
95
Define the Screening Rosette Test
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
Define the Quantitative Kleihauer-Betke test
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
What are other caused of HDNF and Similar diseases?
Maternal Warm Autoimmune Hemolytic Anemia Maternal Alloimmunization to Platelets Maternal Autoimmune Thrombocytopenia
98
Define Maternal Warm Autoimmune Hemolytic Anemia
IgG crosses the placenta and can affect fetus
99
Define Maternal Alloimmunization to Platelets
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
Define Maternal Autoimmune Thrombocytopenia
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
Other causes of fetal or newborn hemolysis, associated anemia, hydrops, or jaundice
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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