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Derm, infectious disease, topical drugs, RBC disorders > Transfusion Medicine > Flashcards

Transfusion Medicine Flashcards

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1
Q

tube testing

A

Immediate spin:
IgM antibodies and insignificant
37ºC phase
IAT phase:
Detects RBCs coated with IgG +/- complement
Antibodies reacting at IAT are more often significant

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2
Q

Blood Groups

A 
Clinically significant
Hemolytic transfusion reaction
Hemolytic disease of the newborn/ fetus
Most significant antibodies 
Require previous exposure  
IgG 
warm reactive (37˚C)
Most insignificant antibodies  
Naturally occurring
IgM 
Cold reactive (below 37˚C)
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3
Q

ABO Blood systems- Type I chains

A

Type 1 chains: glycoproteins and glycolipids free-floating in secretions and plasma

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4
Q

ABO Blood systems- Type II chains

A

Type 2 chains: glycolipid and glycoprotein antigens bound to the red cell membrane

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5
Q

ABO Blood systems- Se gene

A

Se gene modifies type 1 chains to produce H antigen (substance)

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6
Q

ABO Blood systems- H gene

A

H gene modifies type 2 chains to produce H antigen (substance)

H antigen is further modified to make
A antigen
B antigen

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7
Q

ABO Blood systems- O gene

A

O antigen has no further modification of H antigen

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8
Q

ABO blood systems

A

Most important blood group
Genotype determined by three codominant alleles on the long arm of chromosome 9
Antigens are also carried on platelets, endothelium, kidney, heart, lung, bowel and pancreas
ABO antigens are present on fetal RBC’s by 6 weeks of gestation and reach adult levels by age 4

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9
Q

Bombay (Oh)

A

Bombay (Oh)
Lack of H, A and B antigens
Due to lack of H and Se genes (hh, sese)

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10
Q

ABO blood system - antibodies

A 
Antibodies are clinically significant and naturally occurring
Activates complement
Immediate intravascular HTR
Appear at 4 months of age and reach adult levels at age 10
Antibodies may disappear with age
Three antibodies:
Anti-A
Anti-B
Anti-A,B
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11
Q

ABO blood system - antibodies; Group A blood

A

Group A blood: anti-B IgM antibodies that react strongly at body temperatures (37ºC)

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12
Q

ABO blood system - antibodies; Group B blood

A

Group B blood: anti-A IgM antibodies that react strongly at body temperatures

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13
Q

ABO blood system - antibodies; Group O blood

A

Group O blood:
anti-A and anti-B IgG antibodies that react best at body temperatures
anti-A,B IgG against A or B cells
Mild HDFN (most common)

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14
Q

ABO Blood System - Forward typing

A

Forward typing
Red cell grouping
Patient’s red cells agglutinated by test anti-A, anti-B antibodies

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15
Q

ABO Blood System - Reverse typing

A

Serum grouping

Patient’s serum or plasma agglutinated by test A1 and B RBC

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16
Q

Rh System

A

Second most important blood group

Two genes:
RHD (D/-)
RHCE (C/c, E/e)

Antibodies:
D makes most antibodies, then c and E
D is very immunogenic; 80% of D-neg make anti-D
HTR with extravascular hemolysis
Severe HDFN with anti-D and anti-c
Mild HDFN with anti-C, anti-D and anti-e
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17
Q

Rh System - Antibodies

A

Prototypical HDFN
Not first pregnancy unless mom was previously transfused
D-neg mom with D+ baby

Prevention: RhIG (commercially prepared anti-D)
D-neg females at 28 weeks gestation
D-neg females ≤72 hrs. of D+ baby’s birth
D-neg females with pregnancy complications or invasive procedure (amniocentesis, etc..)

Contraindications:
D-neg female who already has anti-D
D+ females
D-neg mom with D-neg baby

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18
Q

RhIG dosing

A

RhIG Dosage:
One full dose vial (300µg) per 30 ml of D+ whole blood

One full dose vial (300µg) per 15ml D+ RBCs
Determine percentage of fetal-maternal hemorrhage:
Fetal blood screen; qualitative
Kleihauer-Betke; quantitative but poorly reproducible
Flow cytometry; quantitative and more accurate

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19
Q

Rh system

A 
KB% x blood volume = baby blood in mom
Blood volume = 70 kg x 70ml/kg = 4900ml
(if no weight is given use 5000 ml)
0.02 x 4900 = 98ml D+ baby blood
98/30 =3.2
Give 4 units RhIG

RhIG rules
If number after decimal is <5, round up
If number after decimal is ≥5, round up twice

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20
Q

Lewis System

A

Similar biochemistry to ABO system
In secretors, Leb mostly formed
In non-secretors, mostly Lea formed
Insignificant, naturally occurring, cold-reacting IgM antibodies

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21
Q

MNS system

A

Anti-M and anti-N: Insignificant, naturally occurring, cold-reacting IgM
Anti-S, anti-s, anti-U: Significant, exposure requiring, warm-reacting IgG
Anti-M is rarely associated with severe HDFN

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22
Q

I system

A 
Antigens are built on 2 types of chains
Simple (i) chains found in neonates
Branched I chains found in adults
Insignificant, naturally occurring, cold-reacting IgM auto-antibody
Auto-anti-I: 
-Cold agglutinin disease 
-Mycoplasma pneumonia infections
Auto-anti-i:
-Infectious mononucleosis
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23
Q

P system

A

Similar biochemistry to ABO system
P antigen is the parvovirus B19 receptor
Pk antigen is receptor for various bacteria and toxins
Insignificant, naturally occurring, cold-reacting IgM
Auto-anti-P:
-Paroxysmal cold hemoglobinuria
-Biphasic IgG autoantibody (bind cold, hemolyzes warm

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24
Q

Kidd System

A

Significant, exposure requiring, warm-reacting IgG (with IgM component)
Can fix complement with IgM component
Severe acute HTR possible
Delayed HTR, anamnestic, intravascular and severe
Mild HDFN

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25
Q

Kell System

A

K antigen low frequency; k antigen high frequency (99.8%)
Anti-K
Most common non-ABO antibody after anti-D
Significant, exposure requiring, warm-reacting IgG1
Most due to transfusion, not pregnancy
Anti-k
Very uncommon due to high frequency antigen
Severe acute or delayed, extravascular HTR
Severe HDFN
McLeod phenotype/ McLeod Syndrome
All Kell antigens decreased
Hemolytic anemias with acanthocytes, myopathy, ataxia, peripheral neuropathy, cardiomyopathy
X-linked chronic granulomatous disease

26
Q

Duffy

A

Anti-Fya more common and significant than anti-Fyb
Significant, exposure requiring, warm-reacting IgG
Severe HTR, delayed and extravascular
Mild, but occasionally severe HDFN
Fy(a-b-) most common phenotype in African-Americans
Fy(a-b-) are resistant to Plasmodium vivax and P. knowlesi infection

27
Q

Blood Donation Permanent Deferrals

A 
High risk behavior for AIDS (IVDA, male-male sex, exposure)
Receiving money for sex
Serologic positivity for HIV, HBV, HCV, HTLV
Viral hepatitis after 11th birthday
Use of transfusion clotting concentrates
History of babesiosis or Chagas disease
Growth hormone from human source
Insulin from bovine sources
Dura mater graft
Lymphoma or leukemia
Medication teratogens: Tegison
vCJD risk
28
Q

Blood Donation 3 year deferrals

A

Recovered from malaria
Immigrants from malaria endemic areas (5 years of living)
Medication teratogens: Soriatane

29
Q

Blood Donation 1 year deferrals

A 
Needle stick or other contact with blood
Sex with person with HIV or hepatitis
Sex with IVDA
Rape victims
Incarcerated >72 hrs.
Paying for sex
Allogeneic blood transfusion
Allogeneic transplant
Living with person with active hepatitis
Receiving HBIG
Tattoos/piercings
Travel to malaria endemic area
Syphilis or gonorrhea
Non-prophylactic  rabies vaccines
Travel to Iraq
30
Q

Other Blood Donation Deferrals

A 
Pregnant: 6 wks. postpartum
Non-routine dental work: 72 hrs.
Immunizations: 2 or 4 week deferrals
Drugs:
Accutaine, finasteride: 30 days
Duasteride: 30 days
Aspirin: 48 hrs.
Plavix or Ticlid: 2 weeks
31
Q

Blood Donation Donor Testing

A 
500 ml taken
ABO/RH
Antibody screen
Anti-HTLV I/II
West Nile Virus NAT
Anti-Trypanosoma cruzi (Chagas)
Serologic syphilis
RPR/VDRL
FTA-ABS
Hepatitis B
HBsAg
Anti-HBc
HBV NAT
Hepatitis C
Anti-HCV
HCV NAT
HIV
Anti-HIV1/2
HIV-1 NAT
32
Q

Preoperative autologous blood donation

A

Less screening than allogeneic
AABB standard: not to be crossed over into regular inventory
Infectious disease screening not required unless units shipped to another facility

33
Q

Type and Screen

A

Type and screen
Records check: Previous antibodies or compatibility problems
ABO/Rh testing
Antibody screen
Group O phenotyped RBCs
Antigens required by FDA: D, C, c, E, e, Fya, Fyb, Jka, Jkb, K, k, Lea, Leb, M, N, P1, S, s

34
Q

Type and Cross Match

A

Major crossmatch: recipient’s serum with donor RBCs

Minor crossmatch: donor serum with recipient’s RBCs

35
Q

Blood Components - RBCs

A

expected to raise HCT 3%, HGB 1% g/dL
Can be measured 15 minutes after transfusion
Can be transfused with NS, ABO compatible plasma and 5% albumin

36
Q

Blood Components - Platelets

A

Expected to raise count 20,000-30,000 in 1 hour

Do not require crossmatch or ABO compatibility

37
Q

Leukoreduction

A

Leukoreduction: reduce the number of WBCs in the blood product
Filters (prestorage) at time of collection
Filters (pretranfusion) at bedside

38
Q

Washing Blood Components

A

Washing: remove 99% of plasma

IgA deficiency

39
Q

Blood Components: Irradiation

A

Irradiation: deactivates T-lymphocytes
Immunosuppression
Intrauterine transfusions, neonatal transfusions
Hematologic malignancies
Granulocyte transfusion
Receiving blood from first degree relative donor
Receiving HLA-matched units

40
Q

Acute Transfusion Reactions Presenting With Fevers

A

Acute Hemolytic
Febrile Non-hemolytic
Transfusion Related Sepsis
TRALI

41
Q

Acute Transfusion Reactions Presenting Without Fevers

A

Allergic
Hypotensive
Transfusion-associated dyspnea
TACO

42
Q

Delayed Transfusion Reactions Presenting With Fevers

A

Delayed Hemolytic

TA-GVHD

43
Q

Delayed Transfusion Reactions Presenting Without Fevers

A

Delayed Serologic
Post-transfusion Purpura
Iron Overload

44
Q

Acute Transfusion Reaction

A

Signs and symptoms present within 24 hours of a transfusion

45
Q

Delayed Transfusion Reaction

A

Signs and symptoms present after 24 hours of a transfusion

46
Q

Signs, Symptoms, and Etiology of Immune Transfusion Reactions

A 
Abdominal, chest, flank or back pain
Pain at infusion site
Feeling of impending doom
Hemoglobinemia
Hemoglobinuria
Renal failure/ Shock
DIC

Type II (antibody-mediated IgG /IgM) hypersensitivity reaction

47
Q

Signs, Symptoms, and Etiology of Non-Immune Transfusion Reactions

A

Asymptomatic hemoglobinuria

Chemical or mechanical damage to blood product

48
Q

Acute hemolytic transfusion reaction - Intravascular

A

Due to ABO incompatibility
ABO antibodies fix complement and leads to rapid lysis
Also seen with other antibodies (Kidd)

49
Q

Acute hemolytic transfusion reaction - Extravascular

A

Usually (but not always) less severe due to lack of systemic complement and cytokine activation
Seen with Rh, Kell, Duffy antibodies

50
Q

Acute hemolytic transfusion reaction - Treatment

A

Hydration/diuresis

Exchange transfusion

51
Q

Transfusion Reaction Work Up

A
  1. STOP THE TRANSFUSION!
  2. Clerical check
    a. Bedside paperwork/ bag check
    b. Blood bank paperwork/ computer check
  3. Draw post-transfusion sample
    a. Visible hemoglobinemia
    b. Compare to pre-transfusion sample
  4. DAT
    a. Demonstrate RBC coating with IgG &/or b. complement in vivo
    b. Positive DAT does not prove AHTR
    c. Negative DAT does not disprove AHTR
  5. Repeat ABO/Rh testing
52
Q

Febrile non-hemolytic transfusion reaction

A

Most frequently reported reaction
Unexplained increase in temperature 1ºC
Etiology: increased pyrogenic substances from WBCs
-Pretransfusion: donor WBCs secrete cytokines in storage bag
-During transfusion: Recipient antibodies attack donor WBCs or vice versa
Treatment
-Antipyretics
-Demerol

53
Q

Symptoms, Mechanism, Treatment and Prevention of Mild Allergic Reactions

A 
Very common
Localized hives
Angioedema
Mild respiratory symptoms
Mild laryngeal edema
Type I (IgE-mediated) hypersensitivity to transfused plasma proteins
Mast cell secretion of histamine and other mediators of allergic reactions

Diphenhydramine IV or oral (prevention)
Wash blood products
May restart transfusion after hives clear

54
Q

Symptoms, Mechanism, Treatment and Prevention of Moderate Allergic Reactions

A 
Stridor
Hoarseness
Wheezing
Chest tightness
Dyspnea
Type I (IgE-mediated) hypersensitivity to transfused plasma proteins
Mast cell secretion of histamine and other mediators of allergic reactions

Diphenhydramine IV
Epinephrine

55
Q

Symptoms, Mechanism, Treatment and Prevention of Severe (anaphylactic) Allergic Reactions

A 
Uncommon
Anaphylaxis very early
Hypotension
Lower airway obstruction
Abdominal distress
Systemic crash
Urticaria
Puritis

IgA deficient recipient with IgE anti-IgA
Haptoglobin deficiency
Latex drugs or foods in donor can lead to severe reactions in recipients

Washed blood products
IgA deficient blood products
Benadryl with corticosteroids
Epinephrine

56
Q

Delayed hemolytic transfusion reactions

A

Extravascular hemolysis at least 24 hours but less than 28 days after transfusion

Etiology
Anamnestic response
-Antibody formed but fades over time
-Anamnestic rapid production of IgG antibody
-Typical for Kidd, Duffy and Kell antibodies
Primary response
-Antibody is quickly formed and attacks still c-irculating transfused red cells

57
Q

Transfusion associated graft vs. host disease (TA-GVHD)

A

Attack on recipient cells by viable T-lymphocytes in transfused blood product

Patients present with

  • Fever 7-10 days post-transfusion
  • Face/trunk rash that spreads to extremities
  • Mucositis, nausea/vomiting, watery diarrhea
  • Hepatitis
  • Pancytopenia

Patients at risk: all those requiring irradiation

Treatment: Irradiate blood products

58
Q

Transfusion Associated Sepsis

A

Transfusion associated sepsis
Acute non-immune transfusion reaction
Due to bacteria in contaminated platelets and RBCs
Staph, strep, Yersinia, bacillus, pseudomonas, E. coli

59
Q

Hypotensive Transfusion Reaction

A

Similar to severe allergic reaction but no skin symptoms, no GI or respiratory issues
>30mm Hg drop in systolic BP; diastolic ≤80mm Hg
Occurs <10 after stop
Associated with patients taking ACE inhibitors or receiving blood with negatively charged filters

60
Q

Transfusion related acute lung injury (TRALI)

A

1 cause of transfusion related fatality in US

New acute lung injury ≤6 hrs. post transfusion
Associated with platelets but also RBC/WB
Two proposed methods
Neutrophils produce toxic free radicals that damage endothelial cells
Donor anti-HLA or anti-neutrophil antibodies bind to recipient antigens and damage endothelial cells
Transfusion

61
Q

Transfusion associated circulatory overload

A

Acute onset of congestive heart failure as a direct result of blood transfusion

62
Q

Post Transfusion Purpura

A

Rare
Marked thrombocytopenia and increased risk of bleeding 10 days following transfusion
Due to antibody against a common platelet antigen
Anti-HPA-1A
PLA1 has a frequency of 98%

Derm, infectious disease, topical drugs, RBC disorders (8 decks)

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