Transfusion Medicine

Question 1

Transfuse to Females who are child bearing age (to prevent hemolytic disease of the newborn in future pregnancies)

Answer 1

Group O, Rh D-negative blood

Question 2

In men & women past childbearing age → ____ blood is okay.

Answer 2

O Rh D-positive

Question 3

Massive Transfusion Protocol of 1:1:1 of what to lower risk of coagulopathy

Answer 3

Plasma/FFP/pRBCs
(or whole blood)

Question 4

Transfusion of more than one blood volume or pRBCs over 24 hours may get ↑ ___ plasma levels
which chelates calcium & magnesium → hypocalcemia → what symptom?

Answer 4

citrate
paresthesias

Question 5

which transfusion reaction occurs within seconds – minutes?

Answer 5

Anaphylactic

Question 6

which transfusion reaction occurs within minutes to just 1 hour?

Answer 6

Acute Hemolytic

Question 7

which transfusion reaction occurs within days to weeks?

Answer 7

Delayed Hemolytic

Question 8

which transfusion reactions (5) occurs within minutes to 6 hours?

Answer 8

Transfusion-transmitted bacterial infection (TTBI)
TACO
TRALI
Non-Hemolytic
Urticarial

Question 9

Presents with respiratory distress (pulmonary Infiltrates/Crackles/edema) ± hypotension ± fever within minutes – hours after transfusion initiation

Answer 9

Transfusion Related Acute Lung Injury (TRALI)
⎻⎻⎻
Tx: immediate transfusion cessation and respiratory supportive care; most patients require ventilatory support.

Question 10

presents with fever , Rigors, tachycardia, + HYPOTENSION within minutes – hours after transfusion initiation

NO laboratory evidence of indirect bilirubinemia

Answer 10

Transfusion-transmitted bacterial infection (TTBI)
⎻⎻⎻
Tx: Broad-spectrum antibiotics
Obtain Cultures from the recipient & the transfused product (to ID pathogen)

Question 11

Presents with respiratory distress (Crackles/edema) + HTN & Afebrile within minutes – hours after transfusion initiation

Answer 11

Transfusion Associated Circulatory Overload (TACO)
⎻⎻⎻
Tx: Diuretic therapy

Question 12

Present with respiratory distress (wheezing) + hypotension ± Angioedema ± rash within minutes after transfusion initiation

Answer 12

Anaphylactic transfusion reaction
⎻⎻⎻
Tx: IM epinephrine, IV antihistamine administration (or vasopressors)
Measure IgA levels

Question 13

Presents with Normal vital signs + hives (rash/itchiness) within 2-3 hours after transfusion initiation

Answer 13

Urticarial transfusion reaction
⎻⎻⎻
Tx: Oral diphenhydramine
If pt is okay → continue transfusion

Question 14

Present with respiratory distress +fever + hemoglobinuria (or flank pain) ± Hypotension/Hemodynamic instability within an hour of transfusion

⎻ Labs show ↑ LDH ↑ indirect Bilirubin

Answer 14

Acute Hemolytic Transfusion Reaction
⎻⎻⎻
Tx: immediate cessation of the transfusion.
Aggressive hydration with IV normal saline
Supportive care measures (± supplemental oxygen, vasopressors)
⎻ Get Coombs test
⎻ If DIC get PT/PTT

Question 15

Presents with extravascular hemolysis within days to weeks after transfusion
unexplained⭣Hgb/Hct + ⭡Indirect bilirubin

Answer 15

Delayed hemolytic transfusion reaction
⎻⎻⎻
TX: If symptomatic → IVIg ± EPO w/ anticoagulation (If plts low)

Question 16

anamnestic antibody response to a red blood cell antigen to which the patient was previously sensitized (ex: pregnancy)

Answer 16

Delayed hemolytic transfusion reaction

Question 17

Presents with TRANSIENT FEVER, CHILLS, and malaise within 1-6 hours of transfusion initiation

NO laboratory evidence of indirect hyperbilirubinemia

Answer 17

Febrile nonhemolytic transfusion reaction (mcc)
⎻⎻⎻
Tx: immediate cessation of the transfusion (to exclude other serious reactions)
and antipyretic (Acetaminophen) administration.

Question 18

Transfusion reaction s/t release of accumulated cytokines in stored blood.
MOST common, benign transfusion reaction

Answer 18

Febrile nonhemolytic transfusion reaction

Question 19

s/t preformed IgE to donor plasma allergen

Answer 19

Urticarial transfusion reaction

Question 20

s/t to Anti IgA antibodies in IgA deficient recipient of blood

Answer 20

Anaphylactic Transfusion Reaction

Question 21

Immediate Cessation of Transfusion &
Tx: IM epinephrine, IV antihistamine administration (or vasopressors)

Answer 21

Anaphylactic Transfusion Reaction

Question 22

Immediate Cessation of Transfusion &
Tx: Oral diphenhydramine
If pt is okay → continue transfusion

Answer 22

Urticarial transfusion reaction

Question 23

Tx: immediate cessation of the transfusion (to exclude other serious reactions)
and antipyretic (Acetaminophen) administration.

Answer 23

Febrile nonhemolytic transfusion reaction

Question 24

Risk factors for what transfusion reaction include→ smoking, alcohol abuse, and critical illness?

Answer 24

TRALI

Question 25

Tx: Broad-spectrum antibiotics
Obtain Cultures from the recipient & the transfused product (to ID pathogen)

Answer 25

Transfusion-transmitted bacterial infection (TTBI)

Sepsis

Question 26

Tx: Diuretic therapy

Answer 26

TACO

Question 27

Tx: immediate cessation of the transfusion.
Aggressive hydration with IV normal saline.
Supportive care measures (± supplemental oxygen, vasopressors)

Answer 27

Acute Hemolytic Transfusion Reaction

⎻Get Coombs test
⎻ If DIC get PT/PTT

Question 28

Tx: immediate transfusion cessation and respiratory supportive care; most patients require ventilatory support.

Answer 28

Transfusion Related Acute Lung Injury
TRALI

Question 29

Leukoreduction of donor blood helps prevent what trasfusion reaction?

Answer 29

Febrile nonhemolytic
transfusion reaction

Question 30

s/t to donor antileukocyte antibodies

Answer 30

TRALI

Question 31

s/t ABO incompatibility

Answer 31

Acute Hemolytic
Transfusion Reaction

Question 32

What Blood pressure is commonly seen with TACO vs TRALI respectively?

Answer 32

TACO → HTN
TRALI → Hypotension/Normotension

Question 33

Which 4 transfusion reactions can present with FEVER ?

Answer 33

Febrile Non-Hemolytic (MCC)
Acute Hemolytic
TRALI
TTBI