Transfusion Medicine II

Question 1

What virus has the highest risk of transmission via blood transfusion?List the infectious complications of transfusion and know their frequencies.

Answer 1

HBV

Question 2

How are RBCs prepared for blood transfusion?

Answer 2

• Step 1: Leukoreduction, takes out RBCs and cytokines, this is done to reduce the transmission of CMV and avoid recipitent’s exposure to HLA alloimmunization.
• Step 2: Irridiation, some donor T cell that are left cause TA GVHD, irridiation inactivates T cells to avoid this complication.
• Step 3: Washing, RBCs are washed with saline solution to remove K, cytokines, Abs and allergens

Question 3

How do we define acute and delayed transfusion reactions?

Answer 3

Acute is < 24 hours, usually within 6 hours of blood transfusion whereas delayed is > 24 hours.It can be immune or non immune mediated.

Question 4

Explain acute hemolytic transfusion reaction.

Question 5

Explain febrile non hemolytic transfusion reaction.

Question 6

Explain sepsis that can potentially arise due to transfusion.

Question 7

Explain allergy reactions due to blood transfusion.

Question 8

Explain anaphylaxis due to blood transfusion.

Question 9

Explain TRALI.

Answer 9

Transfusion Related Acute Lung Injury:
* Symptoms begin during or within 6 hours of transfusion (usually 1-2h)
* Respiratory distress and severe hypoxemia (100% pts)
* “Non-Cardiogenic Pulmonary Edema” (lung infiltrates on CXR) (100% pts)
* Fever & Chills (33% pts)
* Hypotension (32% pts)
It is important to know that cardiogenic edema, compromised heart function or other etiologies that can lead to pulmonary edema.Managment is oxygen and mechanical ventilation.

Question 10

What is the pathophysiology of TRALI?

Question 11

How can we prevent TRALI?

Answer 11

• Massive transformation has higher risks of TRALI
• Number of pregnancies of the donor increases the likelihood since they can develop HLA antibodies.
• Due to this reason transfusion should be done from donors that are male only

Question 12

Explain TACO

Answer 12

Transfusion Associated Circulatory Overload - too much too fast, there can be underlying cardiac or pulmonary disease.
* Dyspnea, orthopnea, cough during or shortly after transfusion
* Positive fluid balance
* Cardiogenic Pulmonary edema on CXR
* Elevated central venous pressure
* Elevated serum BNP, may have elevated pro-BNP
Management - Diuretics, oxygen, phlebotomy may be indicated

Question 13

Compare TACO and TRALI.

Question 14

Explain delayed transfusion reactions.