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Transfusion Medicine 2 Flashcards

1
Q

What are the 2 elements of safe transfusion practice?

A

High quality blood products AND good clinical practice

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2
Q

T/F majority of errors associated with blood transfusion are preventable

A

True (Chart on page 13)
• 15% Incorrect Blood Component Transfused(ICBT)
• 19% Handling and Storage Errors (HSE)
• 9% Avoidable, delayed or undertransfusion (ADU)
• 19% Anti-D formed due to no/incorrect amount of Rh immune globulin given

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3
Q

What are the 3 tests that are performed as part of compatibility testing?

A

Blood type, antibody screen, cross match

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4
Q

What is tested as part of the blood type compatibility testing? (3)

A

Determination of ABO ag on RBC, Antibodies in plasma and Rh (D) status

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5
Q

What is the only situation where RBC isn’t tested before infusion? What is done in this situation?

A

Emergencies - young females receive O Rh negative units and everyone else receives O Rh positive units

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6
Q

Antibody screening as part of the compatibility test is also called (2)

A

Coombs test OR Indirect antiglobulin test

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7
Q

Tranfusion of what 2 blood products is usually preceeded by antibody screen?

A

RBCs and granulocytes

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8
Q

What is cross match testing?

A

Determines whether patient has antibodies to the donor blood

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9
Q

What are the 4 alternatives presented as alternatives to blood transfusion?

A
  • Hematopoietic growth factors
  • Pharmacologic agents of hemostasis
  • Volume expanders
  • Autologous blood collection
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10
Q

What is the hematopoetic growth factor used to limit chronic RBC transfusion?

A

Erythropoeitin

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11
Q

What is the hematopoetic growth factor used to avoid prolonged neutropenia and avoid ris of granulocyte transfusion?

A

G-CSF or GM-CSF

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12
Q

What is the hematopoetic growth factor used to avoid prolonged thrombocytopenia and risk of platelet transfusion?

A

Romiplostim

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13
Q

What is the pharmacological agent of hemostasis that releases von Willebrand factor from endothelium?

A

Desmopressin

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14
Q

What is the pharmacological agent of hemostasis that activates the extrinsic/common coagulationpathway?

A

Recombinant factor VIIa

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15
Q

What is the pharmacological agent of hemostasis that activates the vitamin K dependent clotting factors?

A

Prothrombin complex concentrates

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16
Q

What are the 2 concentrates used for specific factor replacement, used in congenital and acquired hemophilia?

A

Factor VIII and Factor IX

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17
Q

Fibrin sealants, Aprotinin, Tranexamic acid, ε-aminocaproic acid are all [pro / anti] clotting? [Pick one]

A

Pro clotting

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18
Q

Colloid or crystalloid. Which pulls volume from inside cells, distributes to intravascular and extravascular space?

A

Crystalloid

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19
Q

Colloid or crystalloid. Which pulls fluid from interstitial space and distributes to Intravascular space only?

A

Colloid

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20
Q

Saline, hypertonic saline are examples of [colloid or crystalloid]

A

Crystalloid

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21
Q

Albumin, dextran, hydroxyethyl starch (HES) are examples of [colloid or crystalloid]

A

Colloid

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22
Q

Preoperative donation is an example of autologous blood collection what is the major requirement?

A

Patient must have adequate hematocrit and time to replace circulating RBC

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23
Q

T/F: Autologous blood collection eliminates the risk of transfusion reactions

A

False (All below can still happen
)•Clerical errors–> transfusion of wrongpatient’s blood
•Hemolytic transfusion reaction
•Bacterial contamination during collection
•Septic transfusion reaction

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24
Q

What is intra/post operative blood recovery?

A

Shed blood recovered from surgical field or drain, then washed, filtered, reinfused within 4-24 h

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25
What are the 4 contraindications of intra/post operative blood recovery?
* Infection * Malignancy * Hemoglobinopathies * Pharmacologic agents in the surgical field
26
All the following terms describe what type of transfusion reaction? What is the first treatment?•Hemolytic•Febrile•Allergic•Fluid overload•TRALI (transfusion related acute lung injury)•Septic•Metabolic
Immediate transfusion Reactions. First treatment is to stop the reaction
27
T/F: As part of the routine response to an immediate transfusion reaction, remaining blood products are returned to the blood band for culture?
True
28
What is the major cause of acute hemolytic transfusion reaction?
Complement mediated, because of preformed Ab in patient’s plasma causesintravascular lysis of transfused RBC
29
T/F: The usual cause of acute hemolytic transfusion reaction is clerical error
True
30
Within minutes of blood transfusion, fever, chills, hypotension, chest/back pain in a patient are suggestive of _
Acute hemolytic transfusion reaction
31
Hemoglobinemia, hemoglobinuria, increased LDH, increased indirect billirubin, decreased haptoglobin and positive direct antiglobulin test following blood transfusion are all suggestive of _
Acute hemolytic transfusion reaction
32
What causes febrile transfusion reaction?
Release of inflammatory mediators (e.g., IL-1, IL-8) from WBC or platelets--> PGE2 production-->hypothalamic drive to increase body temperature
33
How is febrile transfusion reaction treated? (2)
Antipyretics and leukocyte reduction of RBCs (or platelets)
34
What causes allergic transfusion reaction?
Patient Ab to plasma proteins, rarely IgA
35
What blood products can cause IgA reaction?
Any product
36
Severe allergic reactions to blood products are seen in what patient sub population?
Patients with IgA deficiency
37
Hives, dyspnea, hypotension and anaphylaxis after a transfusion can be suggestive of _ transfusion reaction
Allergic transfusion reaction
38
How are allergic transfusion reactions prevented?
Antihistamines, washed RBCs and products from IgA negative donors
39
What causes TACO (transfusion associated circulatory overload)? What are the 2 at risk populations?
Too much volume infused rapidly. Renal and cardiac insufficiency patients
40
Dyspnea, headache, hypertension and pulmonary edema following transfusion are all suggestive of _
TACO (transfusion associated circulatory overload)
41
Elevated beta natriuretic peptide is a lab finding suggestive of _
TACO (transfusion associated circulatory overload)
42
Transfusion associated non-cardiogenic pulmonary edema (TRALI) is caused by _
Proposed mechanism: Donor anti-HLA or anti-leukocyte Ab reacting with patient WBC
43
What blood products are most associated w/ TRALI?
Plasma and platelets
44
Hypoxia w/in 6 hrs of transfusion is suggestive of what transfusion reaction?
TRALI
45
How are TRALIs prevented? (2)
Minimize blood collection from donors w/ specific antibodies (usually multiparous females) No donation from donors who's products have caused TRALI
46
What is the cause of septic transfusion reaction?
Bacterial contamination of blood product
47
How can you "prove" a septic transfusion reaction?
Culture same organism in patient and blood product
48
What are the 2 major causes of metabolic transfusion reactions?
- Rapid citrate infusion (decreases plasma calcium) | - Aged RBCs causing increased potassium
49
Tingling extremities, perioral tingling, risk of cardiac arrest are all associated with what type of transfusion reaction?
Metabolic
50
How is tingling from decrased calcium treated?
Infusion of calcium gluconate (IV) or calcium carbonate PO
51
What is the cause of delayed hemolytic transfusion reaction?
Primary or memory antibody response to RBCs -> extravascular hemolysis of transfused RBC
52
Decreased hemoglobin, positive direct antiglobulin test, new anti-RBC antibody and increased direct bilirubin are associated with what type of transfusion reaction?
Delayed hemolytic transfusion reaction
53
What causes post-transfusion purpura?
Patient alloAb to platelet Ag, induced bytransfusion, that crossreact with autologous platelets
54
Bruising / bleeding 1-3 weeks post transfusion and profound thrombocytopenia are associated with _
Post transfusion purpura
55
How is post-transfusion purpura treated?
IVIG to prevent splenic clearance of platelets
56
What causes transfusion associated graft v. host disease? What patients are particularly suceptible?
Infusion of T cells that recognize patient cells as foreign, while patient T cells don’t recognize donor cells as foreign. Usually immunocompromised patients
57
Fever, skin rash, diarrhea, hepatitis and marrow aplasia 10-12 days post transfusion are associated with what transfusion reaction?
Transfusion associated GVHD
58
True or false: Transfusion associated GVHD is relatively benign because it is effectively treated with IVIG?
False. More than 95% lethal due to bone marrow failure, no effective treatments
59
How is Transfusion associated GVHD prevented?
Irradiation of cellular blood products
60
What causes iron overload following transfusion? How is it prevented?
Multiple chronic RBC transfusion Prevent w/ RBC exchange vs. transfusion
61
What are the 5 viruses screened for in blood tests?
HCV, HIV, HBV, HTLV and WNV
62
T/F: Lab tests are available for syphillis and t. cruzei (Chagas) for blood products
True
63
T/F:Lab tests are available for ,alaria, Creutzfeld-Jakob disease, gonnorhea, babesiosis for blood products
False. Screened only by history

2 Path Unit (14 decks)

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