transfusion Flashcards
a blood or blood component is donated to man because of? (5)
- trauma (blood loss or surgery)
- inadequate O2 carrying capacity
- decrease coagulation proteins for hemostasis
- donor could be autologous or allogenic
- component therapy (specific component needed)
time limits of infusion
whole blood | packed RBCs
start after 30 mins of removal of storage and completed within 4 hours
time limits of infusion
platelets
infused ASAP after receiving, and completed within 20 minutes
time limits of infusion
fresh frozen plasma (FFP)
transfused ASAP after thawing and completed within 20 minutes
why FFP should be completed within 20 mins?
to avoid loss of labile clotting factors
identification is done during?
specimen collection or before infusion
one unit should be infused within?
1-2 hours
(if slow, within 4 hours)
emergency transfusion
need for emergency transfusion
group O RBCs
emergency transfusion
for child bearing females
Group O negative units
emergency transfusion
T or f: Rh-negative males can receive Rh-positive blood
for older patients
TRUE
if few units of Rh (-) is availanle
emergency transfusion
older females
can receive Rh nega or posi
the blood unit taken must not be returned unless? (3)
- container closure is not disturbed
- blood has not warmed at >10C or placed in cool temperature of <1C
- sealed segment of integral donor tubig is still attached to the container
if the blood unit is returned, what should you note?
indicate reissue
acute/immediate hemolytic transfusion reaction is caused by — due to —
caused by ABO incompatibility due to IgM and complement activation
it is the most severe transfusion reaction and discontinue transfusion immediately if this happens.
acute/immediate hemolytic transfusion reaction
volume of incompatible blood that can cause acute/immediate hemolytic transfusion reaction
10 mL
enumerate the symptoms of acute/immediate hemolytic transfusion reaction (13)
symptoms appear —
- abdominal, chest, flank, and/or back pain
- fever, chills, dyspnea
- tachycardia, pain at site of infusion
- hemoglobinemia, hemoglobinuria
- oliguria/anuria
- hypotension
appears within 24 hours of transfusion
acute/immediate hemolytic transfusion reaction may result to? (4)
- DIC (disseminated intravascular coagulation)
- renal failure
- shock
- death
lab diagnosis of acute/immediate hemolytic transfusion reaction
- increase free hemoglobin
- increase bilirubin after 6 hours
- decrease haptologin
- DAT (+)
most commonly encountered transfusion reaction in which there is an increase temp (at about 1C) within 8-24 hours after transfusion
febrile non-hemolytic transfusion reaction
febrile non-hemolytic transfusion reaction is caused by?
what will you do to avoid this transfusion reaction?
Donor HLA present in WBC and platelets vs. recepient antibodies
use WBC filters or leukopoor RBCs
enumerate the symptoms of febrile non-hemolytic transfusion reaction (7)
- fever, chills
- nausea, vomiting
- increase blood pressure
- tachycardia and tachypnea
increase in body temp of a hypothermic patient to a normal temperature is not a?
febrile non-hemolytic transfusion reaction
the second most common acute, immune complications of transfusion presenting with variety of symptoms that vary according to the reaction’s degree
allergic transfusion reaction
allergic transfusion reaction occurs as a response of recipient antibodies to allergens from the donor blood due to?
- activation of mast cells in the recipient against the allergen
- binding of allergen and mast cells with IgE results to the release of histamine and other granule contents
- anaphylactoid
what type of hypersensitivity that occurs during allergic transfusion reaction?
type I
this refers to allergic transfusion reaction from non-IgE mediated release of mast cell mediators
anaphylactoid
allergic transfusion reaction is caused by — due to that the donor has?
caused by IgE due to that the donor has reagin
what will you do if allergic transfusion reaction occurs?
if mild?
if severe?
- if mild: temporary discontinue transfusion
- if severe: discontinue
what will u do to avoid allergic transfusion reaction?
- administer antihistamines before transfusion
- use washed RBCs
what will u do to avoid allergic transfusion reaction? if SEVERE
give:
- aminophylline
- epinephrine
- corticosteroid
enumerate the symptoms of allergic transfusion reaction (5)
- urticaria
- erythema
- hives
- itching (pruritus)
- anaphylaxis
anaphylactic transfusion reaction is due to —
this can cause?
- plasma proteins
- IgA or anti-IgA
mild urticarial BUT NO FEVER
what will u do to avoid anaphylactic transfusion reaction?
transfuse IgA deficient components
acute reaction with respiratory distress, severe hypoxemia during or within 6 hours of transfusion, this refers to?
this is due to?
transfusion reaction associated lung injury
HLA problems of donor/patient
transfusion reaction associated lung injury is also known as?
- non-cardiogenic pulmonary edema
- transfusion reaction associated lung injury
- transfusion releated acute lung injury
transfusion reaction associated lung injury
the HLA problems cause a reaction of recipient’s WBCs causing — that occlude the —
causing aggregates that occlude the pulmonary circulation
transfusion reaction associated lung injury is the leading cause of?
HLA problems may be with —
Transfusion-associated fatalities
fever or hypotension
pulmonary hypersensitivity edema and allergic pulmonary edema. this is associated to?
transfusion reaction associated lung injury
what will u do to avoid transfusion reaction associated lung injury?
use leukopoor blood
transfusion-associated sepsis is caused by?
bacterial contamination: immunologic or non-immunologic?
endotoxins of gram (-) bacteria
temperature of 2C or more above normal and can be accompanied by hypotension. this refers to?
transfusion-associated sepsis
enumerate the cold-growing bacterias (5)
- Yersinia enterocolitica
- E. coli
- Pseudomonas
- Propionibacterium acnes
- B. cereus
enumerate the symptoms of transfusion-associated sepsis
dryness and flushing of patient’s skin
transfusion-associated sepsis
always check the blood properly.
what u will check?
check for:
- color change
- clots
- cloudiness
- hemolysis
you may perform GS/C
true or false
contamination usually occurs during transfusion.
FALSE.
occurs during phlebotomy or thawing or from contaminated platelet units
this is when the cardiovascular system’s ability to handle additional workload is exceeded. this refers to?
non-immunologic or immunologic?
transfusion-associated circulatory overload
non-immunologic
circulatory overload is an — transfusion reaction
this is common in patient with?
Iatrogenic (physician-caused) transfusion reaction
common in patient with cardiac and pulmonary disease
transfusion-associated circulatory overload
hypervolemia may lead to? (4)
- CHF
- pulmonary edema
- cardiomegaly
- distended pulmonary artery
transfusion-associated circulatory overload
enumerate the symptoms (5)
this can be used for diagnosis
- headache
- dyspnea
- coughing
- chest tightness
- hypertension
Pro-BNP
what will u do to avoid transfusion-associated circulatory overload?
- patient should sit upright
- administer supplemental oxygenation
- start diueresis
- donor blood should be aliquoted
- therapeutic phlebotomy
- slow down transfusion
enumerate the delayed transfusion reactions (4)
- delayed hemolytic transfusion reaction
- transfusion associated graft-versus-host disease
- post-transfusion purpura
- transfusion-induced hemosiderosis
delayed hemolytic transfusion reaction may heppen?
what is the most common sign?
14 days later after transfusion
decreased hgb and hct
delayed hemolytic transfusion reaction may be due to?
increased —
IgG antibodies to Rh, MNSs, Kell, Kidd, and Duffy antigens
destroyed transfused RBCs
detection of new red cell antibodies and associated with secondary response also may be due to primary response. this refers to?
delayed hemolytic transfusion reaction
5-7 days post transfusion fever and mild jaundice, this refers to?
delayed hemolytic transfusion reaction
this is due to proliferation of competent lymphocytes which leads to profound marrow aplasia with a mortality rate >90%
death occurs?
transfusion asosciated graft-versus-host disease
1-3 weeks after first symptoms appear
enumerate the causes of reaction in transfusion asosciated graft-versus-host disease (5)
this occurs —
- fever
- liver problems
- rash
- diarrhea
- pancytopenia (may lead to sepsis and hemorrhage)
occurs 3-30 days after transfusion
what are the reactions that might occur of transfusion-associated graft-versus-host disease
maculopapular rash starts at the center then to the extremeties
high risk of transfusion-associated graft-versus-host disease
what will u use to avoid these?
- infants
- cancer patients
- immunocompromised patients
use IRRADIATED BLOOD COMPONENTS
number of lymphocytes in a bag is determined by?
age of blood component
fresher blood components contain MORE VIABLE T-LYMPHOCYTES
diagnostic testing for transfusion-associated graft-versus-host disease
- skin biopsy
- bone marrow examination
- liver biopsy
- molecular studies
post transfusion purpura is rare, common in?
what is the treatment?
older women
infuse intravenous immunoglobulin
this happens when a person previously sensitized to platelets due to transfusion or previous pregnancy is re exposed via transfusion
post transfusion purpura
why post transfusion purpura is considered as self-limiting?
post transfusion purpura happens — after transfusion.
platelet counts return to normal within 2 weeks
1-24 days
most commonly implicated in post transfusion purpura
what happens when u this kind of transfusion reaction?
Human platelet antigen 1a
severe thrombocytopenia with bleeding
post transfusion purpura reaction destorys
reaction destroys both transfused and autologous platelets
presence of iron deposits in vital organs which is the multiorgan damage secondary to excessive iron accumulation
transfusion-induced hemosiderosis
(non-immunologic)
transfusion-induced hemosiderosis is presence of iron deposits in vital organs which is common in
these vital organs are?
thalassemias and chronic transfusion patients
liver and spleen
treatment for transfusion-induced hemosiderosis (non-immunologic)
what is the alternative to transfusion therapy?
iron chelation therapy
red cell exchange transfusion
chelating agents bind to iron in the tissues removing them via?
urine and/or feces
enumerate the chelating agents (3)
- Deferoxamine
- Oral deferiprone
- Deferasirox
transmission of disease
what is the most common hepatitis?
enumerate the other disease
hepatitis B and C
HIV, Malaria, Syphilis
define iatrogenic
what transfusion reaction is associated with iatrogenic?
it is a physician-caused transfusion reaction
transfusion associated circulatory overload
