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Heme Path > Transfusion complications > Flashcards

Transfusion complications Flashcards

1
Q

Hypotensive reactions manifestations

A

hypotension facial flushing abdominal pain

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2
Q

Why are multiparous women excluded as plasma donors?

A

The antibodies which cause transfusion related acute lung injury are very common in multiparous women

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3
Q

Hct levels in acute hemolytic transfusion reaction

A

decreased

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4
Q

Treatment for acute hemolytic transfusion reactions

A

Hydration to prevent ATN Forced Diuresis with mannitol

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5
Q

How does transfusion related acute lung injury appear on chest x-ray?

A

diffuse bilateral pulmonary infiltrates which are unresponsive to diuretics

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6
Q

Bacterial contamination of (1) units as these units must be stored at room temperature for the (1) to remain functional

A
  1. platelets
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7
Q

Manifestations of Transfusion associated Graft Versus Host Disease

A

skin (severe rash and exfoliation) GI tract (diarrhea) bone marrow (suppression of hematopoiesis leading to bleeding and infection)

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8
Q

How are Transfusion associated Graft Versus Host reactions prevented?

A

Prior irradiation of the blood component to be transfused; this kills any lymphocytes present

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9
Q

What are the two types of delayed hemolytic transfusion reactions?

A

Anamnestic response: within hours due to previous exposure Primary response: within weeks due to IgM to IgG class switching

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10
Q

How can immunocompromised patients be protected from CMV infection by blood transfusion?

A

select seronegative donors for these patients and remove leukocytes

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11
Q

How does drug induced hemolysis present?

A

Same as acute hemolytic transfusion reaction

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12
Q

Treatment for post transfusion purpura

A

Steroids and IV immunoglobulins are used to shut of the immunologic response to the donors’ platelets

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13
Q

This cytokine released during (1) binds to hemoglobin leading to renal vasoconstriction

A
  1. acute hemolytic transfusion reactions NO (EDFR)
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14
Q

What problem can occur as a result of a rapid infusion?

A

Rapid infusion results in chelation of calcium by citrate (which is used as an anticoagulant for blood)

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15
Q

Bilirubin levels in acute hemolytic transfusion reaction

A

increased several hours later

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16
Q

Allergic reactions are caused by (1) response to (2) in the transfused blood plasma

A
  1. host 2. plasma proteins
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17
Q

Acute hemolytic transfusion reactions are associated with release of what cytokines?

A

Anaphylatoxins (C3a ,C5a ) NO (EDFR) bound to hemoglobin leading to vasoconstriction Pro inflammatory cytokines (IL‐1 ,IL‐6 ,IL‐8 ) TNF‐alpha

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18
Q

What are the s/s of chelation of calcium?

A

Circumoral paresthesia and tingling of fingers

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19
Q

A transfusion reaction can progress to what serious complications?

A

severe DIC shock and hypotension bronchospasm acute tubular necrosis from ischemia

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20
Q

How does CMV present in an immunocompetent patient?

A

Mild mononucleosis like syndrome

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21
Q

Transfusion associated circulatory overload is a very common but frequently overlooked complication of transfusion in what patient population?

A

patients with congestive heart failure or renal failure who are by their condition are hypervolemic

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22
Q

What causes hemosiderosis? Who is at risk?

A

Iron overload caused by repetitive transfusions, such as those required by sickle cell patients. This occurs because the body has no physiologic mechanism of getting rid of excess iron

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23
Q

What are the signs of a transfusion associated circulatory overload?

A

During or soon after a transfusion: dyspnea orthopnea (CHF) cough chest pain headache Pulmonary edema HTN hypoxia, rales on pulmonary auscultation

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24
Q

Bacterial contamination of blood units is usually due to (1) and occurs at the time of blood collection

A
  1. skin flora
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25
Q

Transfusion associated Graft Versus Host Disease occurs from (1) present in cellular blood components which can engraft in the immunoincompetent patient recipient

A
  1. T lymphocytes
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26
Q

Bilirubin levels in delayed hemolytic transfusion reaction

A

increased

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27
Q

Manifestations of allergic reactions

A

fever, hives, pruritus and erythema sometimes: N/V, bronchospasm, anaphylaxis

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28
Q

What does a positive direct Coombs’ test indicate?

A

Indicates the presence of antibody on the surface of the transfused red cells

29
Q

LDH levels in delayed hemolytic transfusion reactions

A

increased due to red cell destruction

30
Q

Hemoglobin levels in acute hemolytic transfusion reaction

A

increased leading to hemoglo binemia and hemoglobinuria

31
Q

Why should neonates get blood 7 day old or less for exchange transfusions?

A

To reduce the risk of a storage lesion in which potassium leaks out of RBC during storage

32
Q

Acute hemolytic transfusion reactions lead to rapid (1) mediated lysis of the incompatible RBCs leading to rapid (2) resulting in (3)

A
  1. complement 2. intravascular hemolysis 3. Hemoglobinemia and hemoglobinuria
33
Q

What type of hemolysis is associated with delayed hemolytic transfusion reactions?

A

extravascular - occurs in spleen

34
Q

Compare and contrast post transfusion hep b vs. hep c

A

Hep B jaundice 2 months post transfusion only 5-10% become chronic carriers of disease Hep C non-icteric (no jaundice) 80% become chronic carriers of disease accounts for 1/4 of hep c cases

35
Q

(1) bacteria can thrive in refrigerated blood bag

A
  1. Yersinia and Pseudomonas
36
Q

What type of hemolysis is associated with acute hemolytic transfusion reactions?

A

intravascular

37
Q

Which transfusion reactions are complement mediated?

A

Acute hemolytic transfusion reactions Delayed are not complement mediated

38
Q

Haptoglobin levels in delayed hemolytic transfusion reaction

A

decreased

39
Q

Acute hemolytic transfusion reactions are most often from transfusion of (1)

A
  1. ABO incompatible red blood cells
40
Q

What are the signs of a delayed hemolytic transfusion reaction?

A

lack of the expected rise in Hb one expects from a transfusion

41
Q

Direct Coombs’ test in delayed hemolytic transfusion reaction

A

positive

42
Q

Febrile non hemolytic transfusion reactions are caused by (1) antibodies in the recipients plasma which react with (2) leading to the release of endogenous pyrogens (3)

A
  1. anti‐leukocyte or antiplatelet 2. donor WBC’s 3. IL‐1 ,IL‐6 , TNF‐alpha
43
Q

Delayed hemolytic transfusion reactions are caused by (1) antibodies against?

A

(1) IgG red cell antigens the recipient was sensitized to previously (often via a prior blood transfusion or during a pregnancy)

44
Q

Antibodies most commonly involved in delayed reactions are often of the (1) blood group systems

A
  1. Kell , Kidd, JKA, as well as Duffy, C and E
45
Q

Hypotensive reactions can be occur in patients taking what medication and why?

A

ACE inhibitors. ACE is an inhibitor of bradykinin, therefore ACE inhibitors lead to an increase in bradykinin levels which can lead to a hypotensive reaction

46
Q

What populations does transfusion related graft versus host disease occur in?

A

Bone marrow transplant recipients ,low birth weight infants , congenital immunodeficiency states at risk

47
Q

rare condition occurring in patients who lack (1) who have developed antibody to this antigen from a prior transfusion

A
  1. the platelet antigen (HPA‐1a) refers to post transfusion purpura
48
Q

What are the initial s/s of an acute hemolytic transfusion reaction?

A

Fever back ache headache shaking chills

49
Q

How do you treat transfusion associated circulatory overload?

A

oxygen and diuretics sometimes phlebotomy

50
Q

The antibodies which cause transfusion related acute lung injury are very common in (1) and they are believed to have developed in response to exposure to fetal MHC antigens occurring during prior (2)

A
  1. multiparous women 2. pregnancies
51
Q

Manifestations of post transfusion purpura

A

severe bleeding thrombocytopenia 1-3 weeks post transfusion

52
Q

Manifestations of febrile non hemolytic transfusion reactions

A

fever, chills, and generalized discomfort shortly after or during the transfusion

53
Q

direct Coombs’ test in acute hemolytic transfusion reaction

A

positive direct Coombs

54
Q

Transfusion related acute lung injury is due to antibodies in the donor plasma directed against the recipient’s (1); these are usually (2) antigens

A
  1. WBC’s 2. class I MHC
55
Q

What are the manifestations of allergic reactions in patients who are deficient in IgA?

A

severe anaphylaxis with bronchospasm, laryngeal edema, and hypotension

56
Q

Describe the pathogenesis of TRALI (transfusion related acute lung injury)

A

antibodies in the donor plasma against recipient’s WBC’s pool in pulmonary vasculature leading to capillary leakage leading to pulmonary edema

57
Q

Haptoglobin levels in acute hemolytic transfusion reaction

A

decreased

58
Q

Parvovirus B19 complications in sickle cell patients?

A

Aplastic crisis - bone marrow failure in patients with accelerated hematopoiesis such as sickle cell

59
Q

These reactions occur most frequently during transfusion of fresh frozen plasma

A

Transfusion related acute lung injury

60
Q

How does CMV present in an immunocompromised patient?

A

pneumonia, renal, CNS infection

61
Q

s/s of HTLV‐1 & HTLV‐2

A

T‐Cell lymphoma Demyelinating neuropathy

62
Q

Acute hemolytic transfusion reactions are caused by (1) antibodies against the (2)

A
  1. preformed IgM 2. donor red blood cells
63
Q

In drug induced hemolysis neoantigens are induced on RBC membrane through #1 mechanisms #modification of (2) #Immune complex deposition on (2) #(3) induced sometimes

A
  1. haptene 2. RBC membrane 3. Autoantibody
64
Q

LDH levels in acute hemolytic transfusion reaction

A

increased

65
Q

Manifestations of transfusion related acute lung injury

A

respiratory distress, hypoxia, hypotension , bilateral pulmonary edema (2-3 days after transfusion)

66
Q

Hemoglobin levels in delayed hemolytic transfusion reaction

A

decreased

67
Q

Sensitization of the IgA deficient patient occurs usually from a prior transfusion of plasma containing ?

A

IgA

68
Q

What drugs are associated with drug induced hemolysis?

A

Cephalosporins‐cefotetan & ceftriaxone

69
Q

Hypotensive reactions occur as a result of?

A

bradykinin generated in the plasma

Heme Path (21 decks)

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