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Haemotology > Transfusion (Asare) > Flashcards

Transfusion (Asare) Flashcards

1
Q

Role of IgM in immunohemotology

A
  • Against carbohydrate-based antigens
  • naturally occuring
  • cause of intravascular hemolysis via complement
  • agglutinate at room temp w/o coombs reagent
  • examples: ABO antibodies, cold agglutinins
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2
Q

role of IgG

A
  • against protein-based antigens
  • previous exposure: transfusion or pregnancy
  • cause extravascular hemolysis via RES
  • requires coombs reagent for agglutination
    ex. Rh, Kell, duffy (non-ABO)
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3
Q

RBCs - Universal donor

A

Group O

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4
Q

RBCs - universal recipient

A

Group AB

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5
Q

plasma universal recipient

A

Group O

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6
Q

plasma universal donor

A

group AB

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7
Q

Rh antigen system

A

 D antigen (Rh system)
 Autosomal dominant
 Rh positive (85%)
 Rh negative (15%)
 Highly Immunogenic
 80% of healthy D negative individuals will make anti-D after one unit of Rh-positive blood
 ~20% in hospitalized patients
 15% of Rh-negative women who give birth to an
Rh-positive fetus make anti-D

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8
Q

hemolytic disease of the newborn/fetus

A

hemolysis of renal red cells

  • anemia
  • extramedullary hematopoesis
    • liver, spleen (large immature blood cells in circulation)
  • incidence of hemolytic disease of newborn can be decreased by providing RHig to Rh negative mother during pregnancy and at the time of delivery
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9
Q

Hemolytic newborn disease steps

A

Step 1: Rh+ father

Step 2: Rh- mother carrying her first Rh+ fetus. Rh antigens from the developing fetus can enter the mother’s blood during delivery

Step 3: in response to the Rh fetal antigens, the mother will produce anti-Rh antibodies.

Step 4: in the woman gets pregnant with another Rh+ fetus, her anti Rh antibodies will cross the placenta and damage fetal red blood cells

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10
Q

Packed Red blood cells

A

Indications:

  • restoration of red cell oxygen carrying compacity
  • improve tissue oxygen delivery
  • allevaiation of signs and symptoms of anemia
    • HNT
    • tachycardia
    • dizziness
    • dyspnea
    • decreased tissue perfusion
    • ischemia
  • general guidelines
    • maintain hb >7
    • increased mortality when hb drops to < 5
    • need to keep higher HCT in CAD, pulmonary disease hb >8
  • important to maintain normovolemia even with acute blood loss
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11
Q

platelets

A

Risk of hemorrhage:

  • <5,000-
    • high risk of spontaneous hemorrhage
  • 5,000- 10,000
    • increased risk of spontaneous hemorrhage
    • high risk with trauma, invasive procedures, or ulceration
  • 10000- 50,000
    • variable risk with trauma
  • >50,000
    • bleeding from platelet deficiency uncommon
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12
Q

contraindication for platelet transfusion

A

thrombotic thrombocytopenia (TTP)

heparin induced thrombocytopenia (HIT)

immune mediated thrombocytopenia purport (ITP)

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13
Q

Transfusion criteria for FFP

A

diffuse microvascular bleeding

massive transfusion of more than one blood volume

warfarin overdose with major bleeding or impending surgery

PT > 1.5 x normal in non-bleeding pt scheduled for surgery or invasive procedure

treatment of coagulation pathway defect where specific factor concentrate is unavailable

plasma exchange in TTP or aHUS

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14
Q

Acute Hemolytic Reaction- clinical features

A

Fever, chills, pain at infusion site

  • usually within first 15 minutes of transfusion

flank pain, chest pain, SOB

hemoglobinuria

hemoglobinemia

DIC

shock and cardiovascular collapse

warning: symptoms may be mind and non-specific intially (uneasiness, feeling of impending doom )

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15
Q

Acute Hemolytic reaction - management

A

STOP transfusion

send implicated blood bag to blood bank and draw new sample

Direct coombs test

blood sample from a pt with immune mediated hemolytic anemia: antibodies are shown attached to antigens on the RBC surface

The pt’s washed RBS are incubated with Antiguan antibodies

RBCs agglutinate: antihuman antibodies form links between RBCs by binding to the human antibodies on the RBCs.

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16
Q

Delayed hemolytic transfusion reaction

A
  • Related to Non-ABO Blood groups
    • Incidence 1/1500
  • Extravascular hemolysis
  • Anamnestic Response: 3 days
  • Symptoms: fever, anemia, fatigue,
    weakness
  • Clinical Management dependent on
    severity of hemolysis - Supportive
17
Q

Febrile non hemolytic transfusion reactions

A

Definition: Temperature elevation of 1°C during or within two hours of a transfusion

Pathogenesis: Cytokines (IL-1B, TNF, IL-6) released by leukocytes in blood components

Diagnosis of exclusion

18
Q

Febrile Non-Hemolytic Transfusion Reactions- clinical manifestations

A

Clinical Manifestations
 Usually not life-threatening;
symptoms range from mild to
moderate  Fever, chills, rigors, dyspnea  More severe in chronically transfused
patients

19
Q

Febrile Non-hemolytic Transfusion Reactions
- workup and treatment

A

 Transfusion Reaction Work-up
 New sample (ABO, Ab screen, crossmatch,
DAT)  Urine sample, LDH, Bilirubin,
Haptoglobin

 Treatment:
 Stop transfusion
 Antipyretics & observation

20
Q

Transfusion associated sepsis

A

 Bacterial Contamination
 Platelets: 1:2,000
 RBC’s: 1:500,000

 Patient develops high fever during transfusion

 Rx: antibiotics

21
Q

Transfusion related acute lung injury (TRALI)

A

One of the leading causes of mortality
associated with blood product transfusion  Acute respiratory distress occurring during
or within 6 hours of transfusion  Most common cause of transfusion related
mortality  Severe hypoxemia (O2 saturation <90%)  Acute pulmonary edema  Fever- 1 -2° C  Hypotension– moderate; occasionally
transient hypertension is first sign

Precise mechanism unknown
Antibody Mediated
 HLA class I, HLA class II
antibodies, Granulocyte
antibodies (HNA)  Two-Hit Theory
 Priming of granulocytes
 Therapy
 Supportive respiratory
therapy
 Supplemental oxygen  Mechanical ventilation
 80% resolve in 2-3 days  5-10% Fatality Rat

22
Q

transfusion associated circulatory overall (TACO)

A

Leading cause of mortality associated
with blood product transfusion  TACO is generally related to:
 Underlying medical conditions (e.g. CHF,
ESRD)  Rate of infusion (typically fast)

Signs and Symptoms
 Acute hypoxemia
 Tachypnea
 Dyspnea
 Laboratory testing:
 Elevated brain-naturetic
peptide (BNP)

 Imaging:
 Pleural effusion

Management:

Diuresis often yields rapid symptomatic relief  For patients experiencing TACO, future
transfusions should be run at slower rates
 Blood product transfusions can safely occur up to 4
hours
 Other options include:
 Split units (RBCs, FFP, platelets)
 Alternatives to transfusion (e.g. vitamin K, factor
concentrates, EPO)

23
Q

Allergic transfusion reactions

A

 Very common; 1 –3 % of transfusions;
 Usually benign
 May herald anaphylaxis  Pathogenesis:
 Pre-existing IgE antibody directed against a serum

protein in transfused blood component; IgE attached to mast cells is cross-linked by antigen, causing release of histamine
 Therapy
 Stop the transfusion
 Give diphenhydramine

24
Q

Anaphylactic transfusion reactions

A

Symptoms usually occur very shortly after
the start of the transfusion; NO FEVER  Cutaneous symptoms are prominent:
pruritis, urticaria, flushing, angioedema  Systemic Symptoms:
Anaphylactic Transfusion Reactions
 Severe upper and lower airway obstruction:
hoarseness, stridor, wheezing
 Drop in O2 sats  Cardiovascular symptoms: LOC, shock,
tachycardia, cardiac arrest  GI symptoms; nausea, vomiting, diarrhea,
cramps

25
Q

anaphylaxis

A

Discontinue all blood transfusions  Medications:
 Epinephrine (iv or sq)
 Benadryl IV
 Corticosteroids
 Bronchodilators

 Oxygen  Future transfusions: washed cells
 IgA negative blood

Haemotology (15 decks)

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