Test 5 Flashcards
What is a major crossmatch?
donors cells and patient plasma
When is a major crossmatch performed?
patient has an unknown antibody
what is a antibody screen
patient plasma and known antigens
what is the most common thing done now for transfusions?
type and screen plus immediate spin crossmatch
what does the immediate spin detect?
ABO errors
What is the Type and screen?
ABO/RH and antibody screen
what is type and screen routinely used for?
patients who are not likely to actually need transfusions
during pregnancy to rule out antibodies
identify antibodies that might cause HDN
identify Rh negative mothers
how can the type and screen be tested to see if correct?
immediate spin of donors cells and patient plasma to rule out ABO errors
What type of blood do we transfuse in emergency transfusion?
Group O, Rh negative blood
must have doctors consent
if time is permitted give group and type of patient
what are some adverse complications of transfusion?
hemolytic reactions due to antigen-antibody complexes immediate or delayed hemolytic reactions febrile reactions allergic reactions- urticaria transfusion related acute lung injury bacterial contamination
what is the most severe reaction and what does it cause?
ABO incompatibility
intravascular and extravascular destruction
how long does it usually take a ABO reaction to take place?
within the first 100ml of blood
what are some causes for giving the wrong ABO blood?
drawing the wrong patient mixup of specimens improper labeling of specimens errors in paperwork issuing the wrong unit of blood administering blood to the wrong patient
what are some symptoms of intravascular reactions?
hemoglobinemia hemoglobinuria decreased haptoglobin levels fever, chills, pain at infusion sites, back pain, headache drop in blood pressure shock renal failure
what are some symptoms of extravascular reactions?
falling hemoglobin/hematocrit
fever, jaundice
bilirubinemia
bilirubinuria
what are some symptoms for febrile reactions?
fever and chills
what are febrile reactions caused by?
antibodies against leukocyte antigens
antibodies react with transfused donor white cells
what is a treatment of febrile reactions?
leukocyte-poor blood
most all donor units are now provided by blood banks is pre-filtered to remove what?
majority of leukocytes
what causes allergic reactions?
proteins in transfused plasma from blood unit
what is a symptom of allergic reaction?
urticaria (hives)
what do you treat a patient with a allergic reaction to proteins from a transfusion?
anti-histamine (Benadryl)
what is a very rare allergic reaction and what is it due to?
anaphylactic shock
IgA deficiency in patient
what is the usually cause of bacterial contamination of transfusions?
platelet transfusion because it is stored at room temp
but some bacteria can grow at refrigeration temps
what causes the reaction in bacterial contamination?
reaction to endotoxins
what causes circulatory overload?
rapid infusion of blood or given too much blood
what does circulatory overload cause?
congestive heart failure
what is the length of time the FDA recommends for giving blood?
two to four hour period
when is rapid infusion okay?
when the person is actively bleeding
what does TRALI stand for?
Transfusion related acute lung injury
what causes TRALI?
HLA antibodies from transfused plasma attacks lung tissue causing pulmonary edema
when does TRALI happen?
happens during or within 6 hours of transfusion
donors centers are now only making fresh frozen plasma from male donors, why?
females are more likely to have HLA antibodies due to exposure to fetal leukocytes during pregnancy
what are the steps to take is there is a reaction?
check paperwork for errors
perform ABO/RH and antibody screen on pre and post transfusion patient blood samples
check donor unit ABO/RH
check urine for blood/hemoglobin
perform DAT to look for antibody attached to transfused RBC
culture donor blood bag
what is the old name for HDN
erythroblastosis fetalis
what can cause HDN?
ANY IgG antibody against fetal RBC antigen
HDN is usually mild unless what antibody is involved?
anti-D
is HDN is caused by any antibody besides anti-D what can be done to treat?
phototherapy
how is HDN caused by anti-D treated?
exchange transfusion of the infant
which HDN is not predictable, not preventable, can occur in first pregnancy?
ABO HDN
how is ABO HDN treated?
phototherapy
which mothers and Babies does ABO HDN usually happen in?
group O mothers and Group A babies
Which HDN is very serious?
how is it predictable and preventable?
RH HDN
predictable by antibody titers on mother’s plasma
preventable by administering anti-D antibody to destroy rbcs in mothers circulation before she can build anti-D antibody
what is given to mothers with a chance of RH HDN?
ortho diagnostics
what is the brand name for ortho diagnostics
Rhogam
300 ug will destroy how much RBCs?
15 ml RBCs (30 ml whole blood)
when is Rhogam administered?
at 28 weeks and again within 3 days after delivery of a RH positive infant
when is another time Rhogam is administered?
in spontaneous abortion in RH negative mothers
what is the rosette test?
a screening test to determine if the fetal bleed into mother’s circulation exceeds 30ml of blood
what is a rosette test called?
fetal screen and fetaldex
what do you do if the rosette test is positive?
a semi-quantitative test is performed called Kleihauer-Betke
what prenatal tests are ran for RH RDN?
abo/rh test
antibody screen for anti-D antibody
weak D testing if D negative on initial test
what are post-pardum tests ran?
ABO/RH on cord blood
DAT on cord blood
elution of antibody from baby’s cells to identify antibody
identification of antibody
what are Rhogam criteria?
mother must be D negative, weak D negative
infant must be D positive or weak D positive
mother must not already have anti-D from previous pregnancies
what is used for the exchange transfusion of infant?
Group O negative red cells reconstituted with group AB plasma
what does the exchange transfusion of infant do?
- removes rbcs coated with antibody
- lowers bilirubin level
- corrects anemia
- lowers circulating antibody level
what does donor selection do?
it is to protect donor and blood recipient
How much time should lapse between donations?
8 weeks
What are some requirements for donors?
appear in good health hemoglobin 12.5 gm/dL or greater hematocrit of 38% or greater minimum of 110 lbs blood pressure better than 180/100 pulse between 50 and 100 temperature cannot exceed 99.5
what should the temp not exceed for a donor?
99.5
what should the hemoglobin be for a donor?
12.5 gm/dL or greater
what is the minimum weight for a donor?
110
what should the blood pressure be for a donor?
180/100 or better
what should the pulse be for a donor?
between 50 and 100
what are some reasons for permanent deferrals?
history of hepatitis
previous positive test for hepatitis, HIV or HTLV
history of babesiosis or chagas disease
family history of CID
recipient of Dure mater or pituitary growth hormone
use of needle to inject non-prescription drugs
what are some reasons for temporary deferrals?
Immunizations- 2 weeks for measles, mumps, polio, typhoid, yellow fever
4 weeks for rubella, varicella, hepatitis B vaccine
pregnancy- 6 months
one year- tattoos, needle stick, sex with high risk HIV person, syphilis therapy, transfusion of blood products, rabies vaccine.
in donors. how long do you need to wait after getting immunizations for measles, mumps, polio, typhoid, yellow fever?
2 weeks
in donors, how long do you need to wait after getting immunizations for rubella, varicella, hepatitis B vaccine?
4 weeks
in donors, what are the immunizations that you need to wait 4 weeks?
rubella, varicella, hepatitis B vaccine
in donors, What are the immunizations that you need to wait 2 weeks?
measles, mumps, polio, typhoid, yellow fever
in donors, what do you need to wait 1 year after getting to donate blood?
tattoos, needle stick, sex with high risk HIV person, syphilis therapy, transfusion of blood products, rabies vaccine.
how long should a person wait after having a baby to donate blood?
6 months
