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Hematology/Immunology Part 1 > Transfusion Medicine > Flashcards

Transfusion Medicine Flashcards

1
Q

What is the primary purpose of whole blood donation?

A

Separation into components like RBCs, plasma, cryoprecipitate, and platelets.

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2
Q

How are red blood cells (RBCs) prepared from whole blood?

A

By centrifugation to remove much of the plasma.

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3
Q

What is the goal of pretransfusion and compatibility testing?

A

To provide a blood component that ensures acceptable RBC survival and minimizes harm to the patient.

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4
Q

What is the first step in patient/recipient testing?

A

Proper identification of the patient sample with two independent identifiers.

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5
Q

Why is ABO compatibility testing crucial in pretransfusion testing?

A

It is the foundation of all other pretransfusion testing to ensure donor and recipient compatibility.

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6
Q

What makes Group O the universal donor for RBCs?

A

It lacks A and B antigens on the donor cells.

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7
Q

Why is Group AB considered the universal recipient?

A

It lacks anti-A and anti-B antibodies.

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8
Q

What is the significance of the Rh blood group system?

A

It is associated with hemolytic transfusion reactions and hemolytic disease of the fetus and newborn.

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9
Q

What is the purpose of an antibody screen in transfusion medicine?

A

To detect clinically significant antibodies in the blood donor and intended recipient.

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10
Q

How can hemolytic disease of the fetus and newborn (HDFN) be prevented in RhD-negative pregnant women?

A

By giving Rh immune globulin (RhoGAM).

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11
Q

What is the primary purpose of an antibody screen in blood donors and recipients?

A

To detect clinically significant antibodies.

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12
Q

Why is an antibody screen included in standard prenatal testing?

A

To evaluate the risk of HDFN and assess candidacy for RhIG.

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13
Q

What are clinically significant antibodies?

A

Antibodies that cause decreased survival of RBCs.

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14
Q

What are the primary methods for collecting platelets for transfusion?

A

Whole blood donation and apheresis.

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15
Q

What is the storage temperature and life span of platelets?

A

22°C to 24°C, 5 days.

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16
Q

What are the primary signs and symptoms of transfusion reactions?

A

Fever, tachycardia, dyspnea, chills/rigors, hypotension, tachypnea, nausea and vomiting, pulmonary edema, elevated D-dimer/DIC, hypoxemia, elevated brain natriuretic peptide, pain, rash, pruritis, urticaria, laryngeal tightness, flushing, bronchospasm, angioedema, maculopapular rash.

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17
Q

What are the key symptoms to focus on for transfusion reactions?

A

Fever, dyspnea, rash, hypotension.

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18
Q

What is the focus of the antibody screen?

A

Unexpected antibodies (non-ABO, non-RhD).

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19
Q

What is the expected increase in platelet count from a single donor platelet transfusion?

A

30,000 to 60,000/µL.

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20
Q

What is the main objective of laboratory investigation in a transfusion reaction?

A

Identify a hemolytic transfusion reaction.

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21
Q

What are immune alloantibodies?

A

Antibodies produced in response to RBC stimulation through transfusion, transplantation, or pregnancy.

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22
Q

What are autoantibodies?

A

Antibodies directed against antigens on the patient’s own RBCs.

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23
Q

What factors can affect the actual effect of a platelet transfusion?

A

Patient’s blood volume, underlying clinical problems, ongoing platelet consumptive process, known antibodies, hematopoietic stem cell transplantation, cirrhosis, hypersplenism, fever, and concurrent medications.

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24
Q

What must be done if records and current testing do not agree?

A

Resolve any discrepancy before releasing blood components.

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25
Q

When should therapeutic platelet transfusion be considered in severe bleeding?

A

Maintain platelet count >50,000 µL.

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26
Q

What are the clinical findings associated with acute hemolytic transfusion reaction?

A

Fever, chills/rigors, disseminated intravascular coagulation (DIC), epistaxis, pain and/or oozing at IV site, hematuria, hypotension, back/flank pain, oliguria/anuria/renal failure.

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27
Q

What is required if an antibody screen is positive?

A

Additional testing to identify the antibody and determine its clinical significance.

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28
Q

What is the guideline for platelet transfusion in patients with multiple trauma or traumatic brain injury?

A

Maintain platelet count >100,000 µL.

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29
Q

What is the purpose of a serological crossmatch?

A

To check ABO compatibility and detect antibodies in the patient’s serum that react with donor RBCs.

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30
Q

What evidence indicates hemolysis in acute hemolytic transfusion reactions?

A

Decreased fibrinogen, decreased haptoglobin, elevated bilirubin, elevated LDH, hemoglobinemia, hemoglobinuria, plasma discoloration, spherocytes on blood film.

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31
Q

What is the indication for routine prophylactic platelet transfusion in radiation or chemotherapy-induced thrombocytopenia?

A

Platelet count <10,000 µL.

32
Q

What are the clinical events that suggest a transfusion-transmitted infection?

A

Fever, sepsis, hypotension, tachycardia, generalized edema without an obvious source of infection.

33
Q

What does an electronic crossmatch compare?

A

Recent ABO serologic results and interpretations for both donor and recipient.

34
Q

What is the NHSN definition of TRALI?

A

Acute lung injury onset during or within 6 hours of transfusion cessation, hypoxemia, radiographic evidence of bilateral infiltrates, no prior acute lung injury, and no left atrial hypertension.

35
Q

What is the guideline for prophylactic pre-procedural platelet transfusion for major surgery?

A

When platelet count is <50,000 µL.

36
Q

Can current testing procedures guarantee the fate of transfused blood?

A

No, they cannot guarantee the survival of transfused RBCs.

37
Q

What evidence suggests an immune mechanism for hemolysis in acute hemolytic transfusion reactions?

A

Positive direct antiglobulin test (DAT) for anti-IgG or anti-C3, positive elution test with alloantibody present on transfused red blood cells.

38
Q

What are some primary causes of ARDS?

A

Aspiration, pneumonia, toxic inhalation, contusion, near drowning.

39
Q

What is Fresh Frozen Plasma (FFP) and how is it prepared?

A

Prepared from whole blood or apheresis collection and frozen at –18°C or colder within 8 hours of collection.

40
Q

What are some secondary causes of ARDS?

A

Severe sepsis, shock, multiple traumatic injuries, burn injury, acute pancreatitis, cardiopulmonary bypass, drug overdose.

41
Q

What laboratory evidence supports a transfusion-transmitted infection?

A

Pathogen in the recipient, transfused component, donor at donation time, additional component from the same donation, or another recipient of a component from the same donation.

42
Q

What factors influence the presentation of acute hemolytic transfusion reactions?

A

Type of incompatibility, blood product, volume transfused, individual patient factors, clinical situations like infants, altered mental status, anesthetized patients, ICU setting.

43
Q

What is the goal in selecting red cells for transfusion?

A

To give ABO/Rh type specific and crossmatch compatible blood.

44
Q

What should be done in an emergency if Rh negative blood is not available?

A

Give Rh positive blood to adult males and women past childbearing age.

45
Q

What are the indications for using Fresh Frozen Plasma (FFP)?

A

Management of preoperative or bleeding patients needing multiple plasma coagulation factors, massive transfusion, warfarin reversal, and thrombotic thrombocytopenic purpura (TTP).

46
Q

What conditions must be met to confirm a transfusion-transmitted infection?

A

No other potential exposures to the pathogen and evidence that the recipient was not infected prior to transfusion or that the pathogen strains are related by molecular or phenotypic comparison.

47
Q

What must be established before transfusing any red-cell containing component?

A

Serologic compatibility between recipient and donor.

48
Q

What are the causes of non-immune hemolytic transfusion reactions?

A

Thermal conditions, osmotic incompatibility, chemical incompatibility, mechanical factors.

49
Q

What is the difference between TRALI and ‘Possible’ TRALI/Type II?

A

‘Possible’ TRALI/Type II includes the same criteria as TRALI but with an alternative risk factor for acute lung injury present.

50
Q

What is the RUMC policy for suspected bacterial contamination in transfusion reactions?

A

Culture all platelet products implicated in any transfusion reaction.

51
Q

What are the revised indications for RBC transfusion at Rush for patients with hemoglobin ≤ 7 g/dL?

A

For hospitalized, hemodynamically stable patients.

52
Q

What is TACO?

A

Transfusion Associated Circulatory Overload.

53
Q

What characterizes a delayed hemolytic transfusion reaction?

A

Positive DAT between 24 hours and 28 days after transfusion, alloantibody detected by elution or new serum alloantibody, evidence of hemolysis like inadequate rise or rapid fall in hemoglobin, unexplained spherocytes.

54
Q

What does Cryoprecipitated Antihemophilic Factor (AHF) contain?

A

Fibrinogen, Factor VIII, Factor XIII, vWF, and fibronectin.

55
Q

What are the BEST criteria for detecting positive cultures in suspected septic transfusion reactions?

A

High fever (≥39°C and a ≥1°C increase from pretransfusion temperature), objective criteria for hypotension and tachycardia, and accounting for pretransfusion medication.

56
Q

What are the indications for using Cryoprecipitated Antihemophilic Factor (AHF)?

A

Control of bleeding associated with fibrinogen deficiency, treatment of Factor XIII deficiency, second-line therapy for von Willebrand disease and hemophilia A.

57
Q

What are the revised indications for RBC transfusion at Rush for patients with hemoglobin ≤ 8 g/dL?

A

For hospitalized, hemodynamically stable patients with acute gastrointestinal bleeding, cardiac ischemia, or during the post-operative period.

58
Q

What are the criteria for transfusion-transmitted infection?

A

Unexplained clinical events suggesting infection, fever with/without chills and rigors, sepsis, fever, hypotension, tachycardia, generalized edema, no obvious source of infection.

59
Q

What is TAD according to the NHSN definition?

A

Acute respiratory distress occurring within 24 hours of transfusion cessation, unrelated to allergic reaction, TACO, TRALI, or another underlying condition.

60
Q

What are the key symptoms and differential diagnoses associated with transfusion reactions?

A

Fever, dyspnea, hypotension, rash, hemolytic reactions, circulatory overload, anaphylactic reactions, cutaneous allergic reactions, transfusion-transmitted infections, acute lung injury, graft-vs-host disease.

61
Q

What are the revised indications for RBC transfusion at Rush for patients with hemoglobin ≤ 10 g/dL?

A

For patients with septic shock or acute cerebral ischemia.

62
Q

What characterizes a febrile non-hemolytic transfusion reaction?

A

Occurs during or within 4 hours after transfusion, with no other conditions accounting for the signs and symptoms, and may include fever, chills, or rigors without hemolysis.

63
Q

What are the types of blood components that can be produced from a whole blood donation?

A

Whole blood-derived platelets.

64
Q

What are the criteria for transfusion-associated circulatory overload (TACO)?

A

New onset or exacerbation of respiratory distress, pulmonary edema, elevated BNP or NT-pro BNP, cardiovascular changes, and evidence of fluid overload within 12 hours of transfusion cessation.

65
Q

What distinguishes anaphylactic and anaphylactoid transfusion reactions from other types?

A

Absence of fever and occurrence after transfusion of just a few milliliters of component.

66
Q

How are whole blood-derived platelets prepared for transfusion?

A

They are pooled (5-6 units) to obtain an effective dose for adult recipients.

67
Q

What is the majority source of platelets for transfusion?

A

Collected by apheresis (single donor platelets).

68
Q

What defines transfusion-related acute lung injury (TRALI)?

A

ALI onset during or within 6 hours of transfusion cessation, hypoxemia, radiographic evidence of bilateral infiltrates, and no evidence of ALI or left atrial hypertension prior to transfusion.

69
Q

What are some signs and symptoms of allergic transfusion reactions?

A

Mucocutaneous symptoms like urticaria, pruritis, facial flushing, maculopapular rash, erythema, swelling around the eyes, lips, or tongue, gastrointestinal symptoms like nausea, vomiting, abdominal pain, diarrhea, respiratory symptoms like throat tightness, hoarseness, stridor, wheezing, chest tightness, dyspnea, and cardiovascular symptoms like hypotension, tachycardia, shock.

70
Q

What characterizes a hypotensive transfusion reaction?

A

Decrease in systolic BP of ≥ 30 mmHg and systolic BP ≤ 80 mmHg within 1 hour after transfusion, usually occurring within 15 minutes.

71
Q

What distinguishes anaphylactic transfusion reactions from other types?

A

Severe, life-threatening reactions with profound hypotension and shock, occurring after transfusion of just a few mls of component, and absence of fever.

72
Q

How can hypotensive transfusion reactions be differentiated from other adverse reactions?

A

By excluding other adverse reactions presenting with hypotension and other conditions or medications that could explain hypotension.

73
Q

What is the typical response to cessation of transfusion in hypotensive transfusion reactions?

A

Prompt response within 15-30 minutes to cessation of transfusion and supportive treatment.

74
Q

What symptoms are associated with cutaneous allergic transfusion reactions?

A

Symptoms limited to skin and/or mucocutaneous areas.

75
Q

What systems can be affected by symptoms in anaphylactoid transfusion reactions?

A

Gastrointestinal, respiratory, or cardiovascular systems.

Hematology/Immunology Part 1 (12 decks)

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