Transfusion and transplant facts

Question 1

What causes acute graft rejection?

Answer 1

CD8+ cells or newly produced antibody against donor MHC

Question 1

What causes chronic rejection?

Answer 1

Host T cells recognize donor MHC as self then react against the donor antigens presented on those MHCs

Both cellular and humoral

Question 2

What causes hyperacute graft rejection?

Answer 2

Pre-formed antibodies against donor antigen (type II)

Question 2

Biopsy of lung undergoing chronic rejection would show:

Answer 2

Bronchiolitis obliterans = inflammation and fibrosis of small airways

Question 3

How long does it take for serum sickness to occur?

Answer 3

5-10 days

(Takes some time for antibody to be produced and to complex with antigen)

Question 3

Biopsy of a graft undergoing acute rejection would reveal:

Answer 3

Dense interstitial lymphocytic infiltrate and vasculitis of graft vessels

Question 3

What is the manifestation of chronic rejection of a heart transplant?

Answer 3

Atherosclerosis

Question 5

What are some symptoms of serum sickness?

Answer 5

Fever, arthralgia, proteinuria, lymphadenopathy, urticaria occuring 5-10 days after antigen exposure

Question 6

Biopsy of kidney undergoing chronic rejection would show:

Answer 6

Obliterative vascular fibrosis + glomerulopathy

(Gross exam would show shrunken kidney)

Question 7

Biopsy of kidney undergoing acute rejection would show:

Answer 7

Dense interstital lymphocyte infiltration + destruction of tubules

Question 8

Describe the Arthus reaction

Answer 8

Immune complexes deposit locally after an intradermal injection causing edema, necrosis, and complement activation

(Antibody against antigen in whatever was injected)

Question 9

What causes acute hemolytic transfusion reaction?

Answer 9

Host antibodies against donor ABO (intravascular) or antigen on RBC (extravascular)

Question 10

What must occur before an Arthus reaction can occur?

Answer 10

Previous exposure to the antigen

(think about a man with previous snake bites forming a reaction against antivenom)

Question 10

A child with a history of chronic URI’s develops an anaphylactic reaction after a cross-matched blood tranfusion. What might be the cause?

Answer 10

IgA deficiency - donor blood had IgA in it so patient’s blood mounted an attack

Question 12

Describe serum sickness

Answer 12

A systemic Arthus reaction = antibodies bind antigen in blood and form immune complexes that deposit in various tissues throughout the body

Question 14

What is the result of hyperacute rejection?

Answer 14

Widespread thrombosis of the graft –> ischemia and necrosis

Graft must be removed

Question 15

How do you manage each stage of rejection?

Answer 15

Hyperacute - remove graft

Acute - immunosuppression

Chronic - supportive because damage is irreversible

Question 16

What causes febrile non-hemolytic transfusion reactions?

Answer 16

Host antibody response against donor HLA and leukocytes (type II HS)

Question 17

What is the major cause of serum sickness

Answer 17

Drugs

Question 19

What is the manifestation of chronic rejection of a lung transplant?

Answer 19

Bronchiolitis obliterans

Question 20

Biopsy of lung undergoing acute rejection would show:

Answer 20

Perivascular and peribronchial infiltrates

Question 21

Cellular or humoral?

Hyperacute

Acute

Chronic

Answer 21

Humoral

Either

Both

Question 22

What is the manifestation of chronic rejection of a liver transplant?

Answer 22

Vanishing bile ducts

Question 24

How can one test for the Arthus reaction?

Answer 24

Immunofluorescent staining

Question 25

What is the manifestation of chronic rejection of a renal transplant?

Answer 25

Vascular fibrosis and glomerulopathy