Transfusion

Question 1

Organism - RBC antigen associations

Answer 1

Big I = Mycoplasma pneumonia
Little i = EBV
H and Lewis B = H. pylori
P = Parvovirus B19
Duffy = P. vivax

Question 2

Life span of blood products
pRBCs
FFP
Platelets
Cryoprecipitate

Answer 2

pRBCs - 35 days with CPDA-1, 42 days with Additive Solution

FFP - 1 year at -18C, 7 yearss at -65C with FDA approval, 24 hours after thaw

Platelets - 5-7 days at RT

Cryo - 1 year frozen, 4 hours after thaw

Question 3

Antibodies in hemolytic disease of newborn

Answer 3

anti-AB
anti-D
anti-K
anti-Fya
anti-C
anti-c
anti-S

Question 4

Components of cryoprecipitate

Answer 4

Fibrinogen
vWF
Factor 8
Factor 13

Question 5

Partial D vs weak D vs Rh null

Answer 5

Partial D - altered antigen, may type as D+ but need D- blood

Weak D - decreased levels, may type as D- on immediate spin but IAT D+, can receive D+ blood

Rh null - chronic hemolytic anemia

Question 6

Blood type A2 typing

Answer 6

Forward type - A+

Reverse type - anti-A and anti-B (since make anti-A1 that react with commercial cells)

Question 7

Acquired B typing

Answer 7

Forward type- strong A+, weak B+
(B antigen acquired from bacteria deacetylating A antigen)

Reverse type - anti-B

Question 8

RhIG - one vial covers how much D+ blood?

Answer 8

One vial RhIG = 30 mL blood

Question 9

RhIG - Kleihauer-Betke equation

Answer 9

-Get % fetal (microscopy)
-Assume 5L maternal blood
-Fetal volume = % fetal x maternal volume
- Divide fetal volume by 30 mL
If decimal .0 to .4 - add 1 vial
If decimal .5 to .9 - add 2 vials

Question 10

Bombay vs Para-Bombay phenotype

Answer 10

Bombay: se/se h/h
No H antigens in blood or secretions

Para-Bombay: Se/se or Se/Se h/h
H antigens insecretions only

**Both need anti-H (Bombay) blood

Question 11

Antigens enhanced by enzyme treatment

Answer 11

Enhanced - “A Rotten Kid LIP”
ABO
Rh
Kidd
Lewis
I
P

Question 12

Antigens decreased by enzyme treatment

Answer 12

Decreased - “My Dog Lassie”
MNS
Duffy
Lutheran

Question 13

Lewis A vs Lewis B genetics

Answer 13

Le gene makes Lewis A
Se gene makes H (H + LeA = LeB)

Le Le/le + Se Se/se = Lewis A+ Lewis B+ secretions and Lewis B+ RBCs

Le Le/le + se se = Lewis A+ LewisB- secretions and RBCs

le le + Se Se/se = Lewis A- Lewis B - secretions and RBCs (but still H+ secrtions)

Question 14

Lewis antibodies - type, significance

Answer 14

anti-Lewis
IgM, clinically insignificant

Question 15

I/i antibodies - significanc

Answer 15

anti-I/i
Clinically insignificant

Question 16

Rh antigen nomenclature
R1
R2
R0
Rz

Answer 16

R = D+
R1 = DCe
R2 = DcE
R0 = Dce
Dz = DCE

Question 17

Rh antigen nomenclature
r
r’
r’’
rgamma

Answer 17

r = D-
r = ce
r’ = Ce
r’’ = cE
rgamma = CE

Question 18

MNS antibodies - exposure, type, significance

Answer 18

anti-M/N - natural, IgM, rare significance

anti-S - exposure, IgG, significant

Question 19

Kell antibodies - significance

Answer 19

anti-K and anti-k - both very significant

Question 20

McLeod Syndrome

Answer 20

McLeod syndrome
X-linked, absence of Kell antigens
Acantholytic hemolytic anemia and late onset neuromuscular

Question 21

Duffy antibodies - type, significance

Answer 21

anti-Duffy
IgG, significant

Question 22

Permanent donation deferrals

Answer 22

Dura mater graft
Bovine insulin, HGH or CJD
HBV, HCV, HIV, HTLV
Etretinate
Antiretroviral treatment

Question 23

3 year donation deferrals

Answer 23

History of malaria, residence in malaria country > 5 y

Question 24

1 year donation deferrals

Answer 24

Incarceration > 72 h
Sex with HBV

Question 25

3 mo donation deferrals

Answer 25

Needle stick
HIV risks (MSM, money)
Hx transfusion
Travel to malaria
Syphilis or gonorrhea

Question 26

Vaccine donation deferrals:
No deferral
2 week referral
4 week deferral

Answer 26

Vaccine deferrals:
- No deferral - toxoids, killed or recombinant vaccines
- 2 week - live attenutated, measles, mumps, polio, typhoid, yellow fever
- 4 week - Rubella, Chicklpox / shingles, unlicensed vaccines

Question 27

Donation Physical Criteria
Weight
Temp
Pulse
BP
Hgb/Hct

Answer 27

Donation Criteria:
Weight - > 50 kg
Temp - < 99.5 F
Pulse - 50-100 bpm
Bp - 90-180 / 50-100
Hgb/hct- Females 12.5/38%, Males 13.0/39%

Question 28

Expected change in Hgb from 1u pRBCs

Answer 28

1 g/dL Hgb (3% Hct)

Question 29

Apheresis platelets - adv vs disadv

Answer 29

Apheresis platelets
Adv
- fewer allergic rxns
- less hemolysis from plasma
- single donor so can HLA match

Disadv - lower increment

Question 30

Leukoreduction benefits

Answer 30

Leukoreduction:
- Decreased febrile reactions
- Decreased CMV transmission
- Decreased HLA immunization

Question 31

Irradiation benefits

Answer 31

Irradiation:
- GVHD

Question 32

RBC Washing Benefits

Answer 32

Washed RBCs (remove plasma and Igs):
- Large volume to K sensitive patients, esp neonates when fresh units not avail
- History of plasma-related reactions (eg IgA defic or anaphylactic rxns)

Question 33

Indications for plasma transfusion

Answer 33

Plasma indications:

Bleeding with multiple factor defic:
- Liver disease
- DIC
- Dilutional coagulopathy

Congenital factor defic with no concentrates - 5 and 11

Life threatening anti-coagulation reversal

Question 34

RBC lifespan after irradiatio

Answer 34

Original date or 28 days after irradiation

Question 35

Acute hemolytic reaction
Sx
Labs
Tx

Answer 35

Acute hemolytic reaction
- Sx: fever, pain. Severe: hypotension, dyspnea
- Labs: positive DAT, indirect hyperbiliubinema, schistocytes or spherocytes
- Tx: volume and BP support, maintain urine

Question 36

Transfusion related sepsis
Sx
Dx
Prevention

Answer 36

Transfusion related sepsis
- Sx: fever > 38C with > 1 C increase, rigors, hypotension
- Dx: Gram stain, culture matching patient
- Prevention: clean skin, divert first 10-40 mL to container

Question 37

Febrile non hemolytic reaction
Sx
Dx
Timing
Tx

Answer 37

FNHTR
- Sx: shaking, increase RR, change in BP
- Dx: >38C with > 1 C increase.
- Timing: within 4 hours
- Tx: stop transfusion, check no hemolysis

Question 38

Allergic Transfusion Reaction
Sx
Timing
Tx
Prevention

Answer 38

Allergic Transfusion Reaction
- Sx: urticaria
- Timing: within 4 hours
- Tx: pause transfusion, give antihstamine, resume once resolves
- Prevention: wash products

Question 39

TACO
Sx
Dx
Tx
Prevention

Answer 39

TACO
- Sx: tachycardia, hypertension, dyspnea

-Dx:
Three of more of:
- One of - A) acute or worsening resp compromise, B) Evidence of worsening pulmonary edema (clinical or radiographic)
- CV changes (tachy, BP, EKG)
- Fluid overload (resp to diuretics, weight)
- Releveant biomarker (BNP)

• Tx: stop tfn, O2. diuretics
• Prevention: transfuse at risk patients slowly (2-4 mL/min or 1 mL/kg per hour)

Question 40

Delayed hemolytic reaction
Sx
Labs

Answer 40

DHTR
- Sx: often none but can be fever, anemia, jaundice
- Labs: increased LDH, bilirubin, DAT+, newly positive screen, spherocytes

Question 41

Transfusion associated GVHD
Sx
Prevention

Answer 41

Transfusion associated GVHD
- Sx: erythroderma, vomiting, diarrhea, hepatitis, pancytiopenia
- Prevention: irradiation at risk patients ( tfn from blood relatives or HLA compatible)

Question 42

Indications for irradiation of products

Answer 42

Indications for irradiation:
- Intrauterine transfusions
- Prematurity, low birthweight
- Congenital immunodef
- Heme malignancy
- Stem cell transplant
- Crosmatched or family donation
- Fludarabine therapy

Question 43

Typical cold RBC antibodies

Answer 43

Le a
Le b
M
N
P