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Heme/Oncology > transfusion reactions > Flashcards

transfusion reactions Flashcards

1
Q
  • determines ABO and Rh
  • looks for alloantibodies- mix pt serum with type O RBCs who’s extended phenotype is known
A

type and screen

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2
Q
  • pt serum and donor RBCs are mixed
  • blood selected must be ABO compatible– lack antigens for which the patient has allobodies
  • confirms absence of major incompatibility
A

cross match

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3
Q
  • the most severe hemolytic transfusion reaction
  • from ABO isoagglutinin
  • rapid onset
  • intravascular
  • dose dependent
  • s/sx due to complement system activation
A

acute hemolytic reaction

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4
Q

acute hemolytic reaction symptoms

A

fever/chills/rigors
discomfort at the infusion site
dyspnea
tachycardia
backache and or headache
hemoglobinemia/hemoglobinuria
DIC
hypotension/shock
renal failure
death

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5
Q

what to do for acute hemolytic reactions

A
  • monitor vitals carefully before and during
  • stop transfusion immediately
  • IV fluids and mannitol to prevent acute kidney injury
  • monitor for DIC with coat studies
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6
Q

acute hemolytic reactions are usually the result of…

A

mislabeling or giving to wrong patient

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7
Q
  • usually caused by minor RBC antigen discrepancies
  • extravascular
  • may have no symptoms
  • usually occurs in pts previously sensitized, but have low antibody levels and a negative alloantibody screen
  • 3-10 days after transfusion
  • can cause a drop in hemoglobin and increase in total and indirect bilirubin
  • newly positive serum alloantibody test
  • no specific treatment required
A

delayed hemolytic reaction

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8
Q

what to do for hemolytic reactions

A
  1. make sure the recipient was the right patient
  2. return the blood to the bank with fresh sample of recipient blood
  3. Hgb will not rise expected due to hemolysis
  4. check for AKI or DIC
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9
Q
  • most frequent transfusion reaction**
  • mediated by antibodies against donor leukocyte antigens
  • pts with prior exposure
  • chills and rigors within 12 hours of transfusion
  • at least a 1 degree celsius rise in temperature
  • Hgb increase as expected– no hemolysis
A

febrile non-hemolytic transfusion reaction/leukoagglutinin reactions

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10
Q

what to do for febrile non hemolytic transfusion reactions

A
  • leukocyte reduced blood products make these less frequent and less severe
  • especially before storage
  • pretreatment with acetaminophen
  • can treat with acetaminophen and Benadryl
  • IV corticosteroids may also be used
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11
Q
  • Hives or bronchospasm– related to allogenic plasma proteins found in transfused components
  • risk is low: premedication is not routine
  • mild reactions: transfusion can be temporarily stopped while diphenhydramine is admitted
  • cellular components can be washed to remove plasma in patients with history of severe reaction or autologous blood components
A

allergic reactions

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12
Q
  • starts after only a few ml have been transfused
  • difficulty breathing
  • coughing
  • n/v
  • hypotension
  • bronchospasm
  • LOC
  • respiratory arrest
  • shock
A

anaphylactic reaction

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13
Q

what to do for anaphylactic reaction

A
  • stop transfusion immediately
  • administer epinephrine
  • maybe glucosteroids if severe
  • IgA deficient patients are at risk
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14
Q
  • lymphocytes from the donor attack and cannot be eliminated by an immunodeficient host
  • fever, rash, diarrhea, hepatitis, lymphadenopathy
  • marrow aplasia, severe pancytopenia
  • clinical manifestations appear at 8-10 days and death occurs 3-4 weeks later
A

graft vs host disease

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15
Q

how is graft vs host disease prevented

A

irradiation of cellular components before transfusion to at risk patients prevents lymphocyte proliferation in blood products

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16
Q
  • non cardiogenic pulmonary edema within 6 hours after a blood product transfusion without other explanation
  • surgical and critically ill patients most susceptible, usually with pre existing lung disease
  • sudden acute respiratory distress following transfusion
  • priming of neutrophils by inflammation of lung endothelial microvasculature
  • activation when antibodies in donor plasma bind to recipients leukocyte antigens
  • or sometimes no anti leukocyte Ab are identified so possibly triggered by something in blood product
A

transfusion related acute lung injury (TRALI)

17
Q

what to do for transfusion related acute lung injury (TRALI)

A

supportive treatment

18
Q

how to prevent transfusion related acute lung injury (TRALI)

A
  • male only plasma donors
  • women have more anti- leukocyte Ab in serum, esp after multiparity
19
Q
  • cardiogenic pulmonary edema within 6 hours of transfusion
  • excessive volume or rate of transfusion
  • respiratory distress
  • CV systems changes
  • elevated brain natriuretic peptide (BNP) or N-terminal-proBNP (NT-BNP) relevant marker
  • positive fluid balance
A

transfusion associated circulatory overload (TACO)

20
Q

TACO management

A
  • use the least amount of product needed*
  • stop transfusion
  • diuretics and inotropes
  • supportive care
21
Q

production of maternal IgG antibodies directed against an antigen on fetal cells

A

hemolytic disease of the newborn

22
Q

how does hemolytic disease of the newborn happen

A
  • if Rh (D) negative woman carries Rh (D) positive fetus
  • fetal RBCs can enter maternal circulation from small feto-maternal bleeding episodes (delivery, abortion, ectopic pregnancy, placental abruption, trauma)
  • once produced the antibodies remain in a woman’s circulation and pose a threat for Rh positive fetus
23
Q

prevent hemolytic disease of the newborn (first prenatal visit)

A

screen all women for:
ABO and Rh status
indirect Coomb’s test (determines antibodies to Rh factor in mother’s blood)

24
Q

prevent hemolytic disease of the newborn (28 weeks)

A
  • indirect Coomb’s test

negative: give Rhogam (anti-D-immunoglobulin) (destroys fetal Rh positive cells so mother will not produce anti-Rh (D) in next pregnancy

positive: immune globulin no longer helpful

25
Q

prevent hemolytic disease of the newborn (40 weeks)

A

if more than 12 weeks have passed since anti-D immunoglobulin was given, consider administering again

antepartum treatment:
passive immunization by administration of Rh (D) immune globulin within 72 hours after delivery

26
Q

management of known maternal alloimmunization

A
  • determine the fetal D type, and
  • monitoring for fetal anemia if the fetus is D positive
27
Q

what to do for severe fetal anemia near term

A

delivery

28
Q

what to do for sever fetal anemia remote from term

A

intrauterine fetal transfusion

29
Q

what can hemolytic disease of the newborn cause

A
  • varying degrees of anemia
  • hyperbilirubinemia
  • jaundice
  • hydrops fetalis
  • kernicterus
30
Q
  • prior to birth
  • the baby’s organs aren’t able to handle to anemia
  • heart failure
  • large amounts of fluid buildup
  • risk for being stillborn
A

hydrops fetalis

31
Q
  • after birth
  • most severe form of hyperbilirubinemia
  • buildup of bilirubin in the baby’s brain
  • can cause seizures, brain damage, deafness, and death
A

kernicterus

Heme/Oncology (9 decks)

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