Transfusion

Question 1

Types of transfusion reactions

Answer 1

1. HTRs
2. Chemically/physically induced TRs
3. non-HTRs

Question 2

Possible causes of HTRs

Answer 2

RACC

1. Antibody binding to RBCs
2. Release of Anaphylatoxins
3. Activation of Cytokines
4. Activation of Cimplement Cascades

Question 3

2 types of HTRs

Answer 3

1. Immediate HTRs
2. Delayed HTRs

Question 4

Immediate HTRs occurs ______________________________
________________ the transfusion

Reaction within __________hrs

Induce diuresis by:
__________________________
__________________________

Signs and symptoms:
- fever with back pain
- hemoglobinuria, hypotension, generalized bleeding

EFFECTS IN BLOOD
1. elevated free Hb
2. Elevated bilirubin
3. Decreased Haptoglobin
4. Variable DAT result

Answer 4

Immediate HTRs occurs very soon, during, or just after the transfusion

Reaction within 24 hrs

Induce diuresis by:
Mannitol
Potassium sparing diuretics

Signs and symptoms:
- fever with back pain
- hemoglobinuria, hypotension, generalized bleeding

EFFECTS IN BLOOD
1. elevated free Hb
2. Elevated bilirubin
3. Decreased Haptoglobin
4. Variable DAT result

Question 5

Delayed HTRs

Anamnestic response from previous _____________________
_______________________________

Occur _______________________
___ days after transfusion

S/s:
1. Jaundice
2. Decreasing Hct levels

Common antibodies:
- Anti-Jk^a
- anti-E
- Anti-D
- anti-C
- anti-K
- Anti-Fy^a
- Anti-M

EFFECTS IN BLOOD
1. Decreased Hct and Hb
2. +DAT
3. + Post-transfusion Antibody

Answer 5

Delayed HTRs

Anamnestic response from previous transfusion, transplant or pregnancy

Occur 7-10 up to 140 days after transfusion

S/s:
1. Jaundice
2. Decreasing Hct levels

Common antibodies:
- Anti-Jk^a
- anti-E
- Anti-D
- anti-C
- anti-K
- Anti-Fy^a
- Anti-M

EFFECTS IN BLOOD
1. Decreased Hct and Hb
2. +DAT
3. + Post-transfusion Antibody

Question 6

Most severe HTR

Answer 6

ABO incompatibility

Question 7

Causes of chemically/physically induced TRs(non-immune TRs)

Answer 7

PaFaHappyMirtday

Physical damage - intravascular lysis
Freeze damage - blood warmers
Heat damage - absence of cryopreservatives
Mechanical damage - blood pumps, roller pumps…..

Question 8

Non-HTRs

Answer 8

1. IMMEDIATE non-HTRs
2. DELALYED non-HTRs

Question 9

IMMEDIATE NON-HTRs

Answer 9

FANANTAT

Febrile NHTRs
Aallergic/Urticarial TRs
NCPE/TRALI
Anaphylactic/toid TRs
TACO
Air embolism
TAS

Question 10

DELAYED Non-HTRs

Answer 10

APTIC

Alol immunization
Post-transfution Purpura
TA GVHD
Iron Overload
Citrate overload

Question 11

A.k.a. HDFN

Answer 11

Erythroblastosis Fetalis

Question 12

Conditions for HDFN to occur

Answer 12

B+M+MIgG

1. Baby + Rh/ABO
2. Mother - Rh/ABO
3. Mother spcfc Ab
4. Spcfc Ab mus be IgG

Question 13

Most common HDFN

Answer 13

ABO

Question 14

Most severe HDFN

Answer 14

Rh

Rh > kell

Question 15

Ref temp ——————–
Transport. Temp ———
- plt granulocyte ———

Answer 15

Ref temp ——————– 1-6°C
Transport. Temp ——— 1-10°C
- plt granulocyte ——— 20-24°C

Question 16

Transfusion procedure is checked and monitored by 2 nurses

Answer 16

!!!!

Question 17

Main cause of transfision-related deaths and acute HTRs

Answer 17

CLERICAL ERRORS

Question 18

Spxmn must be collcected within ___ of scheduled transfusion
A. 14 days B. 7 days
C. 3 days D. 48 HOURS

Answer 18

C

Question 19

Central venous access is desirable for ___________

Answer 19

High volume administration or long term therapy

Question 20

Peripheral access with ____________ or catheter is typically sufficient for blood transfusion.

A. 23g needle B. 18g needle
C. 16g needle D. 21g needle

Answer 20

B

Question 21

These TWO should be the only solution used as IV solutions to dilute blood components

Answer 21

Isotonic Saline
5% Albumin

Question 22

Use of this is PROHIBITED since it is hypotonic and will cause RBC lysis

Answer 22

5% Dextrose in Water
(D5W)

Question 23

Use of this solution is PROHIBITED since it contains calcium(initiate coagulation)

Answer 23

RINGER’S LACTATE SOLUTION

Question 24

Why is Infusion slow for the first ______ minutes?

Answer 24

Reason: to observe for signs of transfusion reaction,

10-15 minutes

Question 25

How long is plasma and platelet units transfused?

Answer 25

**30-60 minutes**

Question 26

What is the desirable time to complete a transfusion?

Answer 26

**within 2 hours**

Question 27

1mL in transfusing blood is equal to?

Answer 27

**15 drops**

Question 28

What is the use of blood warmers?

Answer 28

**use for cold blood (causes *hypothermia*)

Question 29

Hypothermia in transfusion results to?

Answer 29

*Cardiac arrhythmia and hemorrhage*

Question 30

Blood warmer is used for:

Answer 30

- patient receiving many units in a **short period of time** - for cold bloods

Question 31

Blood warmer temp. Automatic temp. Control is set to alarm when blood is @?

Answer 31

@*37°C !!!**NOT BE WARMED OVER 38°C**!!! **42°C**

Question 32

**Special considerations in transfusion** For emergency transfusion, what is the appropriate blood type to be given?

Answer 32

Group O, Rh negative **packed RBCs**

Question 33

**Special considerations in transfusion** Maximum bagunits for adults(massive transfusion)?

Answer 33

**8-10 units**

Question 34

**Special considerations in transfusion** Maximum bag units for infants(massive transfusion)?

Answer 34

**> half a unit**

Question 35

**Special considerations in transfusion** Adverse effects of massive transfusion

Answer 35

**CH2DA** (*chada mahigugma*) *C*itrate toxicity and hypocalcemia *H*ypothermia *2*,3-DPG depletion *D*depletion of Coag. Factors & plt *A*ccumulation of biochem and microaggregates

Question 36

**Special considerations in transfusion**

Answer 36

j**IMENE** BTS Intrauterune tranafusion Massive transfusion Exchange transfusion Neonatal RBC transfusion Emergency transfusion

Question 37

Any transfusion should be done within:

Answer 37

4 hours