Transfusion Medicine Flashcards
What is the difference between forward typing and reverse typing?
Forward = mixing the patients red blood cells with a serum containing anti-A, anti-B and anti- AB and seeing which one they agglutinate with. If they don’t agglutinate with any, that means they are O, if they agglutinate with all, that means they are AB.
Reverse typing = the patients sera is exposed to commercially available A cells and B cells to see which one the serum antibodies react with. If theres no agglutination with A cells, that means they don’t have A antibodies so they have A antigen on their RBC. Same for B. no agglutination would mean AB blood.
Which blood type has only H Ag?
Type O blood
What blood type has H + A Ag?
A blood
Which blood type has H + B Ag?
B blood
which blood type has H + A + B?
AB Blood type
What is a secretor? (Se)
Someone who is capable of making ABO antigens in their secretions and plasma
What is the Bombay phenotype?
Blood cells with the absence of H antigen (hh)
Who can Bombay phenotype people receive blood from?
Bombay blood (because their blood has anti H antibodies)
Are Rh anti-bodies naturally occurring?
Nope - exposure to the antigen is needed to make anti bodies
What are the antigens in Rhesus system?
D, Cc, Ee
What does Kell Kill’s mean?
Anti-K is the next most common immune red cell antibody. It can cause hemolytic disease of the newborn and hemolytic transfusion reaction.
What immunoglobulin does anti-Kell present as?
IgG
What is seen on the peripheral blood smear of McLeod phenotype?
Acanthocytes and hemolytic anemia
Chronic granulomatous disease is caused by a deficiency in which enzyme?
NADH oxidase -> no H202 to destroy microbes
What are the antigens present in the Kidd system?
Jka and Jkb
What does treacherous Kidds mean?
Delayed hemolytic transfusion reaction
Because antibodies disappear rapidly so are often not seen on initial AB screen and cross match.
What are the antigens in the Duffy system?
Fya and Fyb
Why are African Americans resistant to plasmodium vivax?
They have the Fyab- phenotype which confers resistance to that plasmodium
Which immunoglobulin will anti Fy antibodies present as? Which reactions can it cause? (Duffy dies)
IgG; HDN and hemolytic transfusion reactions
Which immunoglobulin does anti-M antibody present as?
IgM
What does Lewis Lives mean?
Lewis antibodies are clinically insignificant because transfused red cells shed their Lewis antigens and acquire the Lewis phenotype of the recipient
Also, the antibodies are absorbed by free serum Lewis antigens onto the RBC membrane
When should the specimen from collection be labeled?
At the bedside!!! With time, date and initials of the phlebotomist
What is the difference between type and screen (T&S) and crossmatching?
Type and screen only detects ABO, Rh, and Ab screen
Cross match is actual testing of patients serum compatibility with donor cells
What does the antibody screen aka indirect antiglobulin test aka indirect Coombs test detect?
Antibodies in the patients serum against antigens on commercially available RBCs
What does the direct Coombs test detect?
Autoimmune hemolytic anemia and transfusion reaction work up
What does the indirect Coombs test used for?
Used prior to the blood transfusion and in prenatal testing of pregnant women
What antibodies do you detect at room temperature?
Cold antibodies: IgM
What antibodies do you detect at 37C?
Warm antibodies: IgM-IgG; IgG
Rh, Kell, Kidd and Duffy
What antibodies do you detect with anti human antibodies?
Warm antibodies; IgG that coats the RBC membrane
What is the most common auto antibody?
Benign cold agglutinin
What immunoglobulin do cold agglutination auto antibodies present as?
IgM
What immunoglobulin do warm agglutination auto antibodies present as?
IgG
What infection is cold agglutination disease associated with?
Mycoplasma pneumoniae
What is a cross match?
Mixing the recipient serum with donor RBC to detect agglutination
What is the first thing you do if the patient is reacting poorly to a transfusion?
Stop the transfusion!!!!
Acute and delayed hemolytic transfusion reactions are due to what?
RBC incompatibility
Febrile non hemolytic transfusion reactions are due to what?
Antibodies to donor leukocyte antigens (HLA)
TRALI transfusion reactions are due to what?
Antibodies from donor plasma to recipient WBC
Transfusion related GVHD is caused by what?
Infusion of immunocompetent donor lymph’s to immunocompromised recipient
What are the symptoms of acute hemolytic transfusion reaction? (5)
Hypotension Hemoglobinuria DIC Flank pain Infusion site pain
What are the symptoms of delayed hemolytic transfusion reaction?
Unexplained rise in unconjugated Hgb
Drop in H/H
What are the symptoms of febrile non hemolytic transfusion reaction?
Fever
chills
hypertension
What are the symptoms of allergic transfusion reactions?
Urticaria
What are the symptoms of TRALI?
Non cardiogenic pulmonary edema
ARDS
What are the symptoms of septic transfusion reaction?
Fever Chills Rigors Shock Caused by platelets
What is the pathogenesis of acute hemolytic transfusion reaction?
Pre existing natural IgM antibodies induce complement mediate intra vascular hemolysis
What is the single most common cause of acute hemolytic transfusion reaction?
Proper ID of patient
Is delayed hemolytic transfusion reaction intra or extra vascular hemolysis?
Extra vascular
What Ig does delayed hemolytic transfusion reaction antibodies present as?
IgG
What is the treatment for delayed hemolytic TR?
IVIG
What is the definition of febrile non hemolytic reaction?
A rise in temperature of 1C or greater; fever, chills
What is the treatment of febrile TR?
Antipyretic (acetaminophen); NO ASA!!!
How do you prevent febrile TR?
Pre medicate with antipyretic
Sx of pruritis, urticaria, erythema and cutaneous flushing would cue you into which TR?
Allergic (urticaria)
How do you prevent allergic TR?
Antihistamines
What is the treatment for anaphylactic TR?
Intubate, epinephrine, diphenhydramine with cutaneous sx, aminophylline with bronchospasm
How do you transfuse with patients with IgA deficiency?
Give IgA deficient products
What is the onset of TRALI?
Hours of transfusion
What is the pathogen of TRALI?
Donor antibodies bind with MHC class 1 antigens on neutrophils (in lungs)
What is the manifestation of TRALI?
Non cardiogenic pulmonary edema
When does TRALI resolve?
48-96 hours from onset
What is the treatment of TRALI?
Antipyretic and fluids
Which organisms grow at low temperature and high iron environments?
Yersinia and pseudomonas
Which organisms grow in platelets? (Room temperature)
Staph, strep, salmonella, E. coli, serratia
What transfusion product do you use for symptomatic anemia?
Packed red blood cells
When is packed red blood cells contraindicated?
Volume expansion
Coagulation deficiency
Drug treatable anemia
When is platelet transfusion contraindicated?
Plasma coagulation deficiency
Clinical conditions of rapid platelet destruction (ITP/TTP)
What does irradiation do to platelets/RBC?
Inactivated donor lymphocytes and decreases the risk of GVHD
What is FFP used for?
Coagulation deficiencies
What is a cryoprecipitate transfusion?
Fibrinogen, factor VIII or vWB factor replacement
What is cryoprecipitate used for?
Hemophilia A
VWD
DIC
Factor XIII
What does the Kleihauer Betke test measure?
Fetal Hgb in mothers circulation
What is the only fluid that can be transfused with blood?
Normal saline
