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2 Path Unit > Transfusion Medicine 2 > Flashcards

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
Q

What are the 4 contraindications of intra/post operative blood recovery?

A
  • Infection
  • Malignancy
  • Hemoglobinopathies
  • Pharmacologic agents in the surgical field
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26
Q

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

A

Immediate transfusion Reactions. First treatment is to stop the reaction

27
Q

T/F: As part of the routine response to an immediate transfusion reaction, remaining blood products are returned to the blood band for culture?

28
Q

What is the major cause of acute hemolytic transfusion reaction?

A

Complement mediated, because of preformed Ab in patient’s plasma causesintravascular lysis of transfused RBC

29
Q

T/F: The usual cause of acute hemolytic transfusion reaction is clerical error

30
Q

Within minutes of blood transfusion, fever, chills, hypotension, chest/back pain in a patient are suggestive of _

A

Acute hemolytic transfusion reaction

31
Q

Hemoglobinemia, hemoglobinuria, increased LDH, increased indirect billirubin, decreased haptoglobin and positive direct antiglobulin test following blood transfusion are all suggestive of _

A

Acute hemolytic transfusion reaction

32
Q

What causes febrile transfusion reaction?

A

Release of inflammatory mediators (e.g., IL-1, IL-8) from WBC or platelets–> PGE2 production–>hypothalamic drive to increase body temperature

33
Q

How is febrile transfusion reaction treated? (2)

A

Antipyretics and leukocyte reduction of RBCs (or platelets)

34
Q

What causes allergic transfusion reaction?

A

Patient Ab to plasma proteins, rarely IgA

35
Q

What blood products can cause IgA reaction?

A

Any product

36
Q

Severe allergic reactions to blood products are seen in what patient sub population?

A

Patients with IgA deficiency

37
Q

Hives, dyspnea, hypotension and anaphylaxis after a transfusion can be suggestive of _ transfusion reaction

A

Allergic transfusion reaction

38
Q

How are allergic transfusion reactions prevented?

A

Antihistamines, washed RBCs and products from IgA negative donors

39
Q

What causes TACO (transfusion associated circulatory overload)? What are the 2 at risk populations?

A

Too much volume infused rapidly. Renal and cardiac insufficiency patients

40
Q

Dyspnea, headache, hypertension and pulmonary edema following transfusion are all suggestive of _

A

TACO (transfusion associated circulatory overload)

41
Q

Elevated beta natriuretic peptide is a lab finding suggestive of _

A

TACO (transfusion associated circulatory overload)

42
Q

Transfusion associated non-cardiogenic pulmonary edema (TRALI) is caused by _

A

Proposed mechanism: Donor anti-HLA or anti-leukocyte Ab reacting with patient WBC

43
Q

What blood products are most associated w/ TRALI?

A

Plasma and platelets

44
Q

Hypoxia w/in 6 hrs of transfusion is suggestive of what transfusion reaction?

45
Q

How are TRALIs prevented? (2)

A

Minimize blood collection from donors w/ specific antibodies (usually multiparous females) No donation from donors who’s products have caused TRALI

46
Q

What is the cause of septic transfusion reaction?

A

Bacterial contamination of blood product

47
Q

How can you “prove” a septic transfusion reaction?

A

Culture same organism in patient and blood product

48
Q

What are the 2 major causes of metabolic transfusion reactions?

A
  • Rapid citrate infusion (decreases plasma calcium)

- Aged RBCs causing increased potassium

49
Q

Tingling extremities, perioral tingling, risk of cardiac arrest are all associated with what type of transfusion reaction?

50
Q

How is tingling from decrased calcium treated?

A

Infusion of calcium gluconate (IV) or calcium carbonate PO

51
Q

What is the cause of delayed hemolytic transfusion reaction?

A

Primary or memory antibody response to RBCs -> extravascular hemolysis of transfused RBC

52
Q

Decreased hemoglobin, positive direct antiglobulin test, new anti-RBC antibody and increased direct bilirubin are associated with what type of transfusion reaction?

A

Delayed hemolytic transfusion reaction

53
Q

What causes post-transfusion purpura?

A

Patient alloAb to platelet Ag, induced bytransfusion, that crossreact with autologous platelets

54
Q

Bruising / bleeding 1-3 weeks post transfusion and profound thrombocytopenia are associated with _

A

Post transfusion purpura

55
Q

How is post-transfusion purpura treated?

A

IVIG to prevent splenic clearance of platelets

56
Q

What causes transfusion associated graft v. host disease? What patients are particularly suceptible?

A

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
Q

Fever, skin rash, diarrhea, hepatitis and marrow aplasia 10-12 days post transfusion are associated with what transfusion reaction?

A

Transfusion associated GVHD

58
Q

True or false: Transfusion associated GVHD is relatively benign because it is effectively treated with IVIG?

A

False. More than 95% lethal due to bone marrow failure, no effective treatments

59
Q

How is Transfusion associated GVHD prevented?

A

Irradiation of cellular blood products

60
Q

What causes iron overload following transfusion? How is it prevented?

A

Multiple chronic RBC transfusion Prevent w/ RBC exchange vs. transfusion

61
Q

What are the 5 viruses screened for in blood tests?

A

HCV, HIV, HBV, HTLV and WNV

62
Q

T/F: Lab tests are available for syphillis and t. cruzei (Chagas) for blood products

63
Q

T/F:Lab tests are available for ,alaria, Creutzfeld-Jakob disease, gonnorhea, babesiosis for blood products

A

False. Screened only by history

2 Path Unit (14 decks)

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