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Boards: Coag Transfusion > TRACS > Flashcards

TRACS Flashcards

1
Q

List 11 transfusion reactions from most the least common

A
  1. febrile non-hemolytic transfusion reaction
  2. Respiratory Reaction
  3. Allergic reactions
  4. Hemolytic Reactions
  5. Delayed serologic transfusion reactions
  6. Infections
  7. Hypocalcemia/Citrate Toxicity
  8. Hyperammonemia
  9. Hypotensive transfusion reaction
  10. Post-transfusion purpura
  11. Transfusion associated graftversus host disease
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2
Q

How is febrile non-hemolytic transfusion reaction defined

A
  • acute either non-immunologic or immunologic
  • temp >102.5 and increaed by at least 1.8 since pre-transfusion
  • during or within 4 hours of end of transfusion
  • ruled out: external warming/underlying infection, AHTR, TRALI, transfusion associated infection (either transmission or contamination)
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3
Q

What are the 2 causes for febrile non-hemolytic transfusion reactions?

A
  • donor white blood cell or platelet antigen-antibody reactions (70% in people)
  • proinflammatory mediators in stored blood products
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4
Q

Which blood products have shown to cause FNHTR more commonly in people?

A

PLT products
non-leukoreduced RBC products

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5
Q

How dangerous are FNHTR?

A

not life-threatening but uncomfortable

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6
Q

What are the 3 types of Respiratory Transfusion reactions?

A
  • Transfusion associated Dyspnea
  • Transfusion associated circulatory
  • Transfusion-related acute lung injury
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7
Q

How is transfusion associated dyspnea defined?

A
  • acute respiratory distress during or within 24 hours of end of transfusion
  • r/o TACO, TRALI, allergic reaction, underlying pulmonary disease
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8
Q

How is TACO defined?

A
  • increased blood volume from transfusion
  • acute respiratory distress and hydrostatic pulmonary edema
  • during or within 6 hours of transfusion
  • clinical, echocardiographic, laboratory evidence of LA hypertension or volume overload
  • typically respond positive to diuretics
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9
Q

What is needed to make the definitive diagnosis of TACO

A

no other explanation for circulatory overload AND

  • clinical signs
  • echo
  • radiographs
  • BNP
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10
Q

Who is more at risk for TACO, a patient with acute or chronic anemia?

A

chronic

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11
Q

What are differential diagnoses for TACO?

A
  • TRALI
  • anaphylaxis
  • bacterial contamination
  • PTE
  • hemolytic reaction
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12
Q

How is TRALI defined?

A
  • acute onset immunologic reaction - antigen-antibody interactions in the lungs
  • during or within 6 hours of transfusion
  • acute hypoxemia and non-cardiogenic pulmonary edema on rads
  • r/p prior lung injury, LA hypertension, alternative risk factors for ARDS
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13
Q

What is typically elevated in a donor blood unit that causes ARDS?

A

anti-HLA type I or HNA antibodies - elevated in plasma from multiparous women

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14
Q

What are the two types of TRALI defined in people?

A

TRALI type I - patient without known risk factors for ARDS and:
* acute onset
* hypoxemia (PF < 300 or SPO2 <90 on room air)
* bilateral pulmonary edema on imaging
* no evidence of LA hypertension
* within 6 hours of transfusion
* no temporal relationship to alternative ARDS risk factors

TRALI type II - patients with other risk factor for ARDS or existing mild ARDS but stable resp status before transfusion - stable for 12 hours before transfusion

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15
Q

What blood products are most likely to cause TRALI?

A

plasma
platelets

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16
Q

How are allergic transfusion reactions defined?

A
  • type I hypersensitivity
  • during or within 4 hours of transfusion reaction
  • dogs: urticaria, eryhtema, pruritus, GI, hemoabdomen, collapse
  • cats: respiratory, GI, pruritus
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17
Q

What timing and response to therapy defines an allergic transfusion reaction as definitive versus probably

A

definitive:
* within 1 hour of starting the transfusion
* responds rapidly to cessation of transfusion and supportive care
probable
* after 1 hour but during transfusion
* does not respond rapidly to cessation and supportive care

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18
Q

List potential causes for non-immunologic hemolytic transfusion reactions

A
  • chemical damage
  • thermal damage
  • osmotic damage
  • mechanical damage

immunologic would be blood type incompatibility

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19
Q

What type of sensitivity is a immunologic acute hemolytic transfusion reaction?

A

type II

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20
Q

What are the criteria to diagnose an acute hemolytic transfusion reaction

A
  • within 24 hours of transfusion
  • hyperbilirubinemia, hemoglobinemia, hemoglobinuria, spherocytosis (dogs), or ghost cells
  • inadequate increase in PCV
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21
Q

What type of antibodies are the naturally occuring anti-A antibodies in type B cats?

A

IgM
hemolyzing and hemo-agglutinating

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22
Q

What is the time frame for delayed hemolytic transfusion reactions?

A

24 hours to 28 days after blood product administration

23
Q

What is the mean half life of dog RBC in cats? (xenotransfusion)

A

3.6 days

24
Q

what is the mean half life of type B RBCs in type A cats?

A

2.1 days

25
Q

which DEA type antibody has shown delayed hemolytic transfusion reactions in dogs?

A

DEA 7

26
Q

How is a delayed serologic transfusion reaction defined?

A
  • antibodies against the transfused product without evidence of hemolysis
  • within 24-28 days
27
Q

How can definitve delayed serologic transfusion reactions be diagnosed?

A

unexplained drop in Hct/Hb withint 24 hours to 28 days after transfusion
AND
positive Coombs test

28
Q

What type of blood product is most commonly associated with bacterial contamination and why?

A

fresh platelet transfusion - stored at room temp

29
Q

How is citrate toxicity defined and diagnosed in SA?

A
  • patient received massive transfusion and has impaired hepatic function
  • CS of hypocalcemia
  • hypocalcemia, iCa <0.7

probably 0.71-0.8
possible 0.81-0.9

30
Q

Which blood products contain most citrate?

A

FFP

31
Q

What are complications from citrate toxicity other than hypocalcemia?

A
  • metabolic alkalosis
  • hypernatremia (if sodium citrate used)
  • decreased iMg
32
Q

Who is at risk for transfusion associated hyperammonemia?

A
  • patients receiving outdated blood products
  • patients with decreased liver function (e.g., PSS)
  • neonates with immature liver function
  • patients with hypoperfusion due to shock
33
Q

What is the time frame for diagnosing hypotensive transfusion reactions

A

within 15 min of starting and 1 hour of stopping the transfusion

34
Q

What type of transfusion is most implicated in causing hypotensive transfusion reactions?

A

red cell transfusions

35
Q

what is the suspected cause of hypertensive transfusion reactions?

A
  • activation of contact pathway (FXII) - conversion of high-molecular-weight kininogen to bradykinin => vasodilation + increased vascular permeability

not reported in veterinary patients

36
Q

Define Posttransfusion purpura

A

alloimmunization against platelet antigens (including destruction of own)
5-12 days following transfusion

37
Q

Define transfusion associated graft versus host disease

A

donor lymphocytes engraft on and eventually attack host tissues
48 hours to 6 weeks after transfusion

high mortality rate in people (>90%)

38
Q

Is a closed transfusion collection system preferred over semi-closed or open systems in cats?

A

suggest any can be used - not enough evidence to make strong recommendations

39
Q

What is the recommendation for leukoreduced versus non-leukoreduced blood?

A

insufficient evidence for recommendations

suggest to consider it - decreases rate of FNHTR in humans (PLT and pRBC)

40
Q

When should frehser RBC transfusions be considered in dogs?

A
  • in septic or hemolytic cases (suggestion)
  • in dogs with liver dysfunction requiring massive transfusions (suggestion)

no recommendatiosn on cats

41
Q

When do RBCs expire?

A

After 42 days

42
Q

How should pRBC units be assessed for hemolysis

A
  • recommend checking units for hemolysis prior to administration
  • if >1% hemolysis - don’t use
  • collect from main bag, not RBC segments

measure free hemoglobin, then calculate:
Hemolysis % = (100-Hct) x (plasma free Hb g/dL) / totalHb d/dL)

43
Q

What is the current recommendation on typing and cross-matching transfusion-naive dogs before blood transfusions

A
  • strongly recommend giving DEA neg to DEA neg dogs (to prevent further immunization against DEA)
  • can administer either DEA neg or pos to DEA pos dog - however suggest matching pos to optimize inventory
  • suggest major cross match may not be necessary
44
Q

What is the recommendation for cross-matching before subsequent blood transfusions?

A

strongly recommend cross match in any dog that received a previous transfusion more than 4 days prior

45
Q

What is the recommendation for typing or cross matching dogs before plasma transfusions?

A

insufficient evidence to make recommendations on DEA1 testing or minor cross matches

46
Q

What is the current recommendation on typing and cross matching cats before blood transfusions

A
  • strongly recommend typing
  • suggest cross match before first transfusion
  • strongly recommend cross match before any subsequent transfusion if previous transfusion more than 2 days prior
47
Q

What is the current recommendation on typing and cross-matching cats before plasma transfusions?

A
  • recommend AB typing prior to plasma transfusion
  • insufficient evidence for minor cross matching but recommend it if AB typing not available
48
Q

What is the recommendation for transfusion methods of RBC in cats and dogs?

A

Cats: suggest syringe pump and 18-micron microaggregate filter

Dogs: suggest standard 170-260 micron in-line blood administration set with gravity flow pr with a piston pump, avoid peristaltic or rotary infusion pumps

49
Q

What is the recommendation on ionized Ca monitoring in cats and dogs receiving transfusions

A

suggest to monitor iCa regularly if massive transfusion administered

50
Q

What is the recommendation for the treatment of allergic transfusion reactions?

A

non-anaphylactic
* suggest antihistamine therapy
* suggest avoiding corticosteroid therapy
* insufficient evidence on whether to slow the transfusion rate

anaphylaxis
* recommend immediate epinephrine use

51
Q

Should transfusions rates be slowed after a FNHTR occurs?

A

insufficient evidence
neither recommend for or against

52
Q

What is the recommended response to vomiting in a patient receiving a transfusion

A
  1. stop the transfusion temporarily
  2. asses for serious reactions
  3. restart at slower rate if patient stable and reaction mild
  4. if cardiovascular or respiratory instability - discontinue –> assess unit for bacterial contamination and assess patient and unit for hemolysis
53
Q

What is the recommended treatment for Post-transfusion purpura?

A

corticosteroids or IVIG suggested

54
Q

What is the recommendation for treating dogs with hypocalcemia from citrate toxicity

A

recommend Ca supplementation if iCa <0.9, or at higher values if clinically indicated
suggest considering empirical supplementation during massive transfusion

Boards: Coag Transfusion (13 decks)

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