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Blood Bank 2: Summer 2024 > Transfusion Reactions > Flashcards

Transfusion Reactions Flashcards

1
Q

How to do transfusion reaction workup

A

Perform ABO/Rh type and polyAHG adult DAT on both pre and post-transfusion samples
and get pee specimen

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2
Q

Why do pre-transfusion DAT?

A
  • To make sure post-transfusion DAT positive is due to transfusion
  • The patient could be attacking the donor RBCs after transfusion
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3
Q

Steps of treating transfusion reaction

A
  1. first identified by infusionist
  2. worked up by blood banker
  3. classified by pathologist
  4. treated by doctor
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4
Q

transfusion reaction classifications

A
  • hemolytic vs non-hemolytic
  • acute vs delayed (>24 hr after transfusion)
  • product vs patient
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5
Q

signs and symptoms of transfusion reaction

A
  • hemolysis
  • raise in temp
  • BP change
  • shortness of breath
  • pain
  • limited survival of transfused product
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6
Q

hemolysis signs

A
  • hemoglobinuria
  • hemoglobinemia
  • hgb level doesn’t rise
  • DAT pos
  • agglutination on slide
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7
Q

T/F
Plt ABO mismatch cannot cause HTR

A

False
It can bc some leftover plasma in the product may contain adverse antibodies

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8
Q

symptoms associated with raise in temp

A

fever
chills
nausea/vomiting

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9
Q

hypotension can lead to ____

A

shock

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10
Q

hypertension can lead to ____

A

jugular vein distension

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11
Q

shortness of breath associated with ___

A

wheezing
anaphylaxis
hypoxemia
angioedema

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12
Q

acute HTR clinical presentation

A
  • rapid onset
  • fever
  • pain
  • hypotension
  • hemoglobinemia/hemoglobinuria
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13
Q

acute HTR major complications

A
  • DIC
  • renal failure
  • shock
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14
Q

cause of acute HTR

A

complement activation

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15
Q

acute HTR essential lab tests

A
  • clerical/visual checks
  • ABO retype
  • tests for hemolysis: DAT, bilirubin, haptoglobin, urinalysis
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16
Q

managing acute HTR

A
  • treat DIC and shock
  • avoid clerical/technical error
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17
Q

delayed HTR clinical presentation

A
  • time-delay onset
  • fever
  • unexplained H/H drop
  • mild jaundice
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18
Q

major complications of delayed HTR

A

none

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19
Q

cause of delayed HTR

A

anamnestic

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20
Q

essential lab tests for delayed HTR

A
  • DAT
  • H/H
  • tests for hemolysis: bilirubin, haptoglobin, urinalysis
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21
Q

managing delayed HTR

A

provide antigen-negative results

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22
Q

severity factors for HTR

A
  • antigenicity
  • titer
  • ability to fix complement
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23
Q

which antibodies cause delayed HTR, DAT pos, and are extravascular

A
  • Kidd
  • Duffy
  • Kell
  • MNS
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24
Q

which antibodies cause acute HTR, DAT pos or neg, and are intravascular?

A
  • ABO
  • Rh
  • Kell
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25
Q

febrile non-hemolytic transfusion reaction prevention (FNHTR)

A

leuko-reduced products

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26
Q

FNHTR symptoms

A
  • fever/chills
  • nausea
  • tachycardia
  • hypertension
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27
Q

FNHTR causes

A
  • WBC-derived cytokines in stored product or HLA antibodies in donor component plts
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28
Q

FNHTR lab findings and treatment

A
  • negative DAT
  • no visible hemolysis
  • treat with acetaminophen (Tylenol)
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29
Q

allergic reaction prevention

A

use of a different donor’s blood products

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30
Q

allergic reaction symptoms

A
  • urticaria
  • itching
  • trouble breathing
  • hives
  • flushing
  • hypotension
  • anaphylaxis
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31
Q

allergic reaction causes

A

allergens and proteins in donor product (IgA antigens in plasma)

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32
Q

allergic reaction lab findings and treatment

A
  • negative DAT
  • no visible hemolysis
  • treat with antihistamine (benadryl)
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33
Q

urticarial vs maculopapular rash

A
  • urticarial: take benadryl and you’ll be fine
  • maculopapular: BAD, means graft v host disease
34
Q

prevention of graft v host disease

A

irradiation of cellular products to inactivate donor lymphocytes

35
Q

symptoms of graft v host disease

A
  • maculopapular rash
  • fever
  • diarrhea
  • multi-organ failure
  • 90% mortality rate
36
Q

causes of graft v host disease

A

recipient does not recognize donor lymphocytes as foreign, but the donor lymphocytes attack the recipient’s RBCs

37
Q

graft v host disease lab findings

A
  • pancytopenia
  • biopsy shows donor lymph infiltrates
  • may have bystander infections
38
Q

graft v host disease treatment

A
  • stem cell transplant
  • immunosuppressive treatment
  • treat symptoms
39
Q

transfusion associated lung injury (TRALI) prevention

A

increase donor deferral for females who have been pregnant and males who have received transfusions

40
Q

TRALI symptoms

A
  • severe respiratory distress
  • severe hypoxia/edema
  • fever
  • hypotension
41
Q

TRALI causes

A
  • donor WBC anti-HLA antibodies reactive against recipient WBCS
  • recipient primed WBCs activated by biologically active substances in transfused blood products
42
Q

TRALI lab findings

A
  • recipient positive for HLA/HNA antigens
  • donor product positive for HLA/HNA Ab
  • chest x-ray has perfusions
43
Q

TRALI treatment

A
  • stop transfusion
  • supportive therapy w oxygen supplementation/mechanical ventilation
44
Q

TACO prevention

A
  • check lab values before transfusion
  • use small volume products for transfusion (split products)
  • transfuse slowly
45
Q

TACO symptoms

A
  • dyspnea
  • coughing
  • hypertension
  • tachycardia
46
Q

TACO causes

A
  • volume infusion that can’t be processed by pt
  • high rates/volumes of infusion
  • underlying pathology e.g., CHF
47
Q

TACO lab findings

A
  • elevated BNP
  • no serological hemolysis
48
Q

TACO treatment

A
  • oxygen supplementation
  • diuresis
49
Q

TRALI risk-factor

A

pt who received plasma from multiparous (pregnant multiple times) female

50
Q

TACO risk factor

A

low circulation or heart output pt

51
Q

graft v host disease risk factor

A

immunocompromised pt

52
Q

prevention of sepsis

A
  • focus on plt expiration dates, proper storage conditions, and bacterial testing of products
  • be aware plts pose highest sepsis risk even if irradiated bc stored at RT
53
Q

sepsis symptoms

A
  • body temp more than 2 degrees above normal
  • rigors (shaking chills) + hypotension
54
Q

sepsis causes

A
  • bacterially contaminated product transfused
  • plts: gpcs, gnb (enterics)
  • rbcs: gpcs, gnb (enterics)
  • plasma: water bath contaminants
55
Q

sepsis lab findings

A

blood culture on patient matches product (find same organism in donor bag and pt)

56
Q

sepsis treatment

A

ID contaminant and antibiotics

57
Q

iron overload (hemosiderosis) prevention

A

transfusion of less than 20 cells in a year or transfusion of washed cells

58
Q

hemosiderosis symptoms

A
  • yellow-tinge to skin
  • multi-organ failure
59
Q

hemosiderosis causes

A

accumulation of iron in tissues
too many transfusions

60
Q

hemosiderosis lab findings

A

extremely elevated ferritin

61
Q

hemosiderosis treatment

A
  • therapeutic phlebotomy
  • chelation therapy
  • exchange transfusion
62
Q

citrate toxicity prevention

A
  • ingestion of calcium before infusion
  • washed products
63
Q

citrate toxicity symptoms

A
  • paresthesias (tingling or prickling sensation)
  • hypotension
  • cardiac arrhythmia
  • tetany (involuntary muscle contractions)
  • coagulopathy
63
Q

citrate toxicity causes

A

inability of liver to metabolize amount of anticoagulant infused

64
Q

patients at risk for citrate toxicity

A
  • liver disfunction/renal disease
  • neonates
  • hypothermic pt
  • plt and FFP recipients
65
Q

citrate toxicity lab findings

A
  • hypocalcemia
  • hypomagnesemia
  • prolonged PT
66
Q

citrate toxicity treatment

A

calcium

67
Q

post transfusion purpura prevention

A

plt crossmatch or HLA matched plt transfusion

68
Q

post transfusion purpura symptoms

A
  • profound thrombocytopenia
  • bleeding
  • petechiae
69
Q

post transfusion purpura causes

A

patient has plt antibody, usually anti-hpa1

70
Q

post transfusion purpura lab findings and treatment

A
  • HLA lab workup to determine antibody ID
  • treat with IVIG or transfusion of diff product, pooled products might help
71
Q

recognition of tranfusion reaction by nurse

A
  • fever
  • chills
  • respiratory distress (coughing, wheezing, dyspnea)
  • hyper or hypotension
  • pain: abdominal or at infusion site
  • skin color/texture changes
  • jaundice
  • hemoglobinuria/emia
  • nausea/vomiting
  • unexpected bleeding
  • oliguria/anuria
72
Q

clinical eval and management of transfusion reaction

A
  • stop transfusion, continue w IV saline
  • document clerical recheck btwn patient and component
  • contact treating physician
  • monitor pt vitals
  • contact transfusion service
73
Q

What to do if DAT is pos for IgG?

A

Elution

74
Q

Goal of transfusion reaction workup

A

rule out hemolytic transfusion reaction

75
Q

steps of transfusion workup testing (preanalytical, analytical, postanalytical)

A

preanalytical: clerical check and visual hemolysis check
analytical: DAT and ABO re-type
postanalytical: report findings to supervisor or transfusion service med director

76
Q

further workup if hemolysis present

A
  • elution
  • repeat screens on pre and post
  • chem tests (LDH, bilirubin, hemoglobin, haptoglobin)
77
Q

further workup if sepsis sus

A

blood culture patient, donor unit, and saline attached to unit

78
Q

further workup if lung injury sus

A
  • contact blood manufacturer for follow-up testing on donor (HLA)
  • chest x ray
79
Q

when to report to FDA?

A
  • when donor product is at fault for causing transfusion reaction, even if it’s just wrong donor selection
  • sepsis
  • TRALI
  • hemolytic
80
Q

when is it not necessary to report TRN to FDA?

A
  • delayed HTR
  • allergic reactions
  • febrile non hemolytic
  • circulatory overload

Blood Bank 2: Summer 2024 (8 decks)

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