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Tranfusion Med > Transfusion Medicine Things to Review > Flashcards

Transfusion Medicine Things to Review Flashcards

1
Q

Antigens Enhanced with Enzymes (Ficin, Papain)?

A

A Rotten Kidd ABO-related ABO-H Lewis System I System P System Rh System Kidd System

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2
Q

Antigens Decreased with Enzyme (Ficin, Papain)?

A

My Dog Lassie MNS System Duffy System Lutheran System

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3
Q

Dose Dependent Antigens?

A

Kidd, Duffy, Rh, MNS

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4
Q

Neutralizing Substance: ABO

A

Saliva (Secretor)

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5
Q

Neutralizing Substance: Lewis

A

Saliva (secretor for Le^b)

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6
Q

Neutralizing Substance: P1

A

Hydatid cyst fluid Pigeon egg whites

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7
Q

Neutralizing Substance: Sd^a

A

Human urine

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8
Q

Neutralizing Substance: Chido, Rodgers

A

Serum

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9
Q

Determining A1 vs. A2 present?

A

Dolichos biflorus

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10
Q

Lectin for H Specificity?

A

Ulex europaeus (causes antigluttination)

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11
Q

Lectin: N Specificity

A

Vicea graminea

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12
Q

Lectin: T Specificity

A

Arachis hypogea

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13
Q

Lectin: T, Tn Specificity

A

Glycine max

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14
Q

Lectin: Tn specificity

A

Salvia

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15
Q

General: Warm vs. Cold Antibodies

A

Warm: IgG Exposure HDFN HTRs Significant Cold IgM Naturally Occcuring No HDFN No HTR Insignificant

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16
Q

Type 1 vs. Type 2 Chains

A

Type 1: Secretion -B1-3 -H is made by FUT2 genes Type 2 Chains: -B1-4 -RBC Membranes H is made by FUT1 genes

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17
Q

Terminal Sugars (A vs. B)

A

A: GalNac N-acetylgalactosamine B: Gal Galactose

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18
Q

What Chromosome are A,B,O genes on?

A

Chromosome 9

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19
Q

Different between A and B vs. AB antibodies?

A

A and B produce IgM antibodies ***Cannot cross the placenta Group O: Anti-A,B is IgG

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20
Q

A1 vs. A2

A

80% A1 20% A2 A1 has 5x as many antigen than A2 1-2% A2, 25% A2B form anti-A1: Insignificant unless 37 C

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21
Q

Acquired B Phenotype

A

A1 RBC contact enteric Gram Negative organisms Colon cancer, GI obstruction, Gram(-) sepsis AB forward typing A reverse typing Result of deacytlation of A1 sugar –> making it look like a B sugar

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22
Q

How do you resolve an Acquired B Phenotype?

A

Acidify serum (pH 6.0) Use monoclonal anti-B that does not recognize acquired B

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23
Q

Bombay Phenotype

A

Do NOT have an H antigen on the phenotype Have strong anti-A, anti-B, anti-H

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24
Q

Le gene (FUT3)

A

Allows you to make Lewis A

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25
Q

Le gene (FUT3) and Secretor Gene (FUT2)

A

Can make Lewis A and Lewis B

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26
Q

Lewis antigens

A

Adsorb onto surface of RBCs Le^b much better than Le^a Therefore, adult RBCs are usually Le(a-b+)

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27
Q

Clinical Significance of Lewis Antibodies?

A

Clinical Insignificant Usually IgM Also, Fetal RBCs lack Le antigens…cord blood is Le(a-b-)

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28
Q

H.pylori, Norwalk virus attach via which antigens?

A

H, Le^b

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29
Q

H.pylori, Norwalk virus attach via which antigens?

A

H, Le^b

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30
Q

Le(a-b-) children are increased susceptibility to what?

A

E.coli UTI’s

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31
Q

I System

A

ABO-related, Type 2 Chains I in adults, i in children (Big I in adults, little i in kids) Little i = linear branch

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32
Q

Auto-anti-I

A

Mycoplasma pneumonia Cold agglutinin Disease

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33
Q

Auto-anti-i

A

Infectious mononucleosis

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34
Q

P-Group

A

P1 only official antigen P is the receptor for Parvovirus Anti-P1 is cold, insignificant IgM

35
Q

Paroxysmal Cold Hemogloinuria (PCH)

A

Biphasic IgG vs. P antigen Attaches when cold Complement attaches when heated Donath-Landstiner biphasic hemolysin Causes: Syphilis Now viral infections in kids

36
Q

Rh Blood Group, Fisher-Race Notation

A

If “R” is capital…you have a big D If “r” is lowercase…you have a little d… R1 or r’ means capital C R2 or r’’ means lowercase E R0 means Dce r = dce Rz = DCE r^y = dCE

37
Q

Rh Antibodies

A
  • Exposure requiring war-IgG
  • HTR’s, primarily extravascular
  • Prototypic HDFN with anti-D
  • Severe HDFN with anti-C
38
Q

Frequency of Rh Antigens

A
39
Q

Partial D

A
  • Lack certain D epitopes on exterior part of RBC via RHD mutation
  • Antigens to the missing parts….anti-D
40
Q

Kidd Blood Group

A
  • Jk^a > Jk^b (Rule of B exception)
  • Exposure requiring warm IgG
  • Dose depdendent
  • Delayed HTR’s
  • Mild HDFN at worst
41
Q

MNS Blood Group

A
  • Glycophorin A and B
    • Glycophroin A: M and N
    • Glycophorin B: S, s, and U
  • Frequencies:
    • M = N
    • s > S
    • S-s-U- in 2% of African Americans, but never in Caucasians
42
Q

MNS Antibodies

A
  • Anti-M and -N
    • “Natural”
    • IgM
    • Insignificant
  • Anti-S, -s, and -U
    • Exposure
    • IgG
    • Significant
43
Q

Duffy Blood Group

A
  • Fy^a and Fy^b are the main antigens
  • 68% of African Americans are Fy(a-b-)
    • The FyFy genotype –> Fy genotype produces no Duffy glycoprotein on RBC’s
  • Exposure requiring warm IG
    • Marked dosage (like Kidd)
    • Variable expression (like Kidd)
    • Delayed HTR’s (like Kidd)
44
Q

Malaria Resistance

A
  • Fy(a-b-) Resistant to Plasmodium vivax infection
  • Duffy glycoprotein is receptor for P.vivax merozites

How to remember: Duffy ends with a “y”….vivax also ends with “x”….both near the end of the alphabet.

45
Q

Kell Blood Group

A
  • K = K1, 9% Caucasians, 2% AA
  • k = K2, 99.8% of population has
  • Js^b, Js^a, Kp^b, Kp^a

Note:

  • Kx
    • Xk protein expresses Kx blood gropu antigen
    • Closely attached to Kell antigens on RBC surface
46
Q

Kell Antibodies

A
  • Anti-K
    • Most common after D
    • Exposure requiring warm IgG
    • Severe HRT’s andHDFN
  • Anti-k
    • Like Anti-K….just uncommon
47
Q

McLeod “syndrome”

A
  • X-linked
  • Absence of Kx
  • Decreased Kell antigens
  • Acantholytic hemolytic anemia
  • Chronic Granulomatous Disease association
48
Q

Who regulates Allogeneic Donation?

A

FDA!

AABB accredited (can’t shut things done…but people need for business)

49
Q

Deferrals for variant CJD

A
  • 3 months in UK (1980-1996)
  • 6 months in Military in europe (1980-1996….they got beef from England)
  • If you lived in Europe for 5 years (1980-now)
    *
50
Q

Immunizations (Deferrals)

A
  • Four Week
    • Rubella
    • Varicella
  • Two Week
    • Measles
    • Mumps
    • Oral Polio
    • Yellow Fever
    • Oral Typhoid
  • Unlicensed:
    • 12 months
51
Q

Medication Deferrals

A
  • Anti-platelet issues
    • ASA: 48 hours
    • Clopidogrel, Ticlopidine, Vorapaxar: 2 weeks
  • Herparin/Warfarin: Plasma Products: 7 day deferral
  • DTI: 2 day deferral
52
Q

Physical Criteria for Donating

A
  • Weight: >110 lbs
  • Temperature: <99.5F (we only test platelets for bacteria)
  • Pulse: 50-100
  • BP: 90-180/50-100
  • H/H:
    • Females: 12.5 g/dL, 38%
    • Males: 13.0 g/dL, 39%
53
Q

How much blood do you draw?

A
  • Amount drawn: 500 +/- 50 mL
  • Can’t do more than 10.5 mL/kg samples!

Time Limit:

  • More than 15 minutes, only make RBCs
54
Q

Age for Blood Collection

A
  • 15-17 y/o depending on state
55
Q

Concerns for Autologous Transfusion

A
  • Donor reactions
  • Clerical errors
  • Bacterial contamination
  • TACO (Transfusion Associated Circulatory Overload)
  • Cost (over 50% tossed)
  • Time (too close to surgery…can’t get back)
  • Positive RTTI Tests
56
Q

Platelet Donors

A
  • Hgb = same as Whole Blood Donors
  • >48 donors between single donations
  • 7 days between double/triples
  • Only up to 2x per week, 24 times/week
  • Must wait 8 weeks after Whole Blood Donation
  • Pre-count: >150,000
57
Q

Who do you have to weigh before donation?

A
  • Only plasma donators!
  • 14.4 L for donors weight > 175 lbs
58
Q

Double RBC Donors

A
  • Remember 8 week for WB
    • 4 to recover RBC’s, 4 for safety
  • 2 RBC Unit Donation:
    • 16 weeks!
    • 8 for recovery, 8 for safety
59
Q

Vasovagal Reaction vs. Hypovolemia vs. Hyperventiliation

A
  • Bradycardia
  • Hypotension
  • Syncope
  • N/V and incontinence
  • Tx: Elevate feet, reassure, cold compresses on neck

Hypovolemia:

  • Tachycardia
  • Hypotension
  • Syncope
  • Tx: IV Fluids

Hyperventilation:

  • SOB
  • Seizures (rare)
  • Tx: Breath into a paper bag
60
Q

Arterial Puncture

A
  • Rapid filling of bag (less than 4 minutes)
  • Bright red blood
  • Pulsatile or vibration of needle
  • Rapidly expanding hematoma
  • Risks:
    • Hematoma: 50-100 times more common
    • Nerve compression
    • Pseudoaneurysm
    • Compartment Syndrome
  • Tx: Stop Collection!
    • Direct pressure for AT LEAST 10 minutes!
    • If no radial pulse…call ED or call medical director
    • Wrap with Coban
    • Advise donor to avoid strenousd activity: 4 hours minimum
61
Q

Pseudoaneurysm

A
  • Leakage of blood into surrounding tissue with persistent communciation.
  • Clot forms – compresses nearby structures
  • On X-ray….look like an aneurysm.
  • Doppler can diagnose (movement of fluid into sac)
  • Tx: Surgical repair
62
Q

Arteriorvenous Fistulas

A
  • Bruit over left antecubital fossa
  • Needle punctures vein and artery creating “connection”
  • Requires surgical repair
63
Q

Infection from Donation

A
  • Source:
    • Improper scrub technique
    • Never re-palpate after insertion
  • Sx:
    • Rubor: Erytheme
    • Calor – local heat
    • Dolor: Pain
    • Tumor: Swelling
  • Tx: Antibiotics!
64
Q

Citrate Effect

A
  • Anticoagulant binds free calcium
  • Perioral tingling
  • Tetany and arrhythmias very uncommon
  • Tx:
    • Oral calcium
    • Slow rate of infusion!
65
Q

3 Day Rule for Cross-match

A
  • If you collect a sample, it can be used for cross-match for any transfusion up to 3 days, NOT 72 hours.
  • Example:
    • You collect sample Sunday at 2 pm
    • Can be used for cross-matched for any transfusion until Wednesday at midnight.
    • Thursday –> need a new sample.
66
Q

Type & Screen

vs.

Type & Crossmatch

A
67
Q

Anticoagulant/Preservatives

A
  • CPD and CP2D: 21 day Red cell storage
  • CPDA-1: 35 day Red cell storage
  • Acid Citrate Dextrose (ACD): 21 days: apheresis collections
68
Q

Why do we have Additive Solutions?

A
  • Result in a product with more adenine for ATP generation
  • AS-1 and AS-5 have mannitol for RBC preservations
  • Allow for 42 day storage (+1 week)
69
Q

Red Blood Cells

A
  • 350 mL (including additive)
  • RBC’s
  • Plasma
  • WBCs and PLTs
  • Anticoagulation
  • Addictive solution
  • 200-250 mg Iron
70
Q

AABB Recommendations for Transfusion

A
  • Hospitalized, hemodynamically stable patients;
    • Adult and Pediatric ICU: 7 g/dL or less
    • Post-op patients:
      • 8 g/dL or less
      • Or Sx!
  • Hospitalized, hemodynamically stable patients with preexisting cardiovascular disease:
    • Hemoglobin: 8 g/dL or less
    • OR Sx
71
Q

RBC Dosing

A
  • Hematocrit increased 3%
  • Hgb increased 1 g/dL
    • Non-bleeding, non-hemolyzing patient
  • Obtain s/p 10-15 minutes
72
Q

RBC Storage Details

A
  • RBC:
    • 35 days with CPDA-1
    • 42 days with AS (Additive Solution)
  • Frozen RBCs (40% Glycerol)
    • 10 years at -65 C
  • Washed RBCs
    • 24 hours, 1-6 C
  • Irradiated:
    • Original expiration date or 28 days (whichever is sooner)
73
Q

What Fluids are Compatible with Transfusion?

A
  • Normal saline
  • ABO compatible plasma
  • 5% albumin
74
Q

Apheresis Platelets

A
  • Must have 3.0 x 10^11 platelets
75
Q

Platelet Shelf Life?

A
  • 5 days
  • Whole-Blood Derived: 4 hours…
76
Q

Platelet Recommendations

A
  • Give at <10,000
  • Lumber Puncture
    • 50,000
  • Prophylactic Plt Transfusion:
    • Nonneuraxial surgery
  • Cardiopulmonary bypass
    • If there’s perioperative bleeding
77
Q

Leukocyte Reduced Products

A
  • <5 x 10^6 WBC’s per unit
  • Benefits:
    • Decrease febrile transfusion reactions
    • Decreased HLA immunization
      • Foreign HLA antigens are presented by donor lymphocytes
      • May lead to formation of HLA antibodies
    • Decreased CMV transmission
      • CMV ONLY in WBC’s
  • Contraindications!
    • Don’t use it in Transfusion-Associated GVHD
    • Frozen Products don’t have enough WBC’s to help
    • Granulocytes – why? You’re collecting the white cells
78
Q

Transfusion Associated Graft vs. Host Disease

A
  • Rare
  • Fever 7-10 days, rash, mucositis, hepatitis, marrow fibrosis/aplasia
  • Symptoms:
    • BONE MARROW FAILURE
    • Almost always failure
79
Q

Prevention: Irradiation

A
  • Dose:
    • 25 Gy to central portion of container
    • 15 Gy to any point in the components
  • This will inactive donor lymphocytes…which will cause GVHD
80
Q

Why Wash Blood?

A
  • Remove “allergic” plasma proteins
    • IgA deficiency
    • Allergic reactions refractory to medical therapy (e.g., refractory to steroids)
  • Neonatal Alloimmune Thrombocytopenia
    • Anti-HPA-1A in 80%
  • Unwanted electrolytes – pediatric patients
81
Q

Cryoprecipitate

A
  • Plasma doesn’t need QC….
  • Minimum Requirements:
    • 150 mg Fibrinogen
    • >80 IU Factor VIII
    • Other Components:
      • vWf
      • Factor VIII
      • Factor XIII
      • Fibronectin
  • Storage: <-18C for 12 months

When do you use it:

  • Fibrinogen deficiency
    • Congenital
    • Acquired
  • Treatment of vWD
  • Bleeding Uremic patients (after DDAVP)
  • Fibrin Glue

Note: NO Factor VII

82
Q

Granulocytes

A
  • Stored at 20-24 C (no agitation)
  • 24 hour storage period
  • ABO compatible
  • As required:
    • CMV negative
    • HLA compatible
    • Irradiated
  • Indications:
    • Severe neutropenia (<500/uL)
83
Q

DDAVP

A

Tranfusion Med (1 decks)

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