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Clinical Medicine: Hematology and Oncology > Transfusion Reactions > Flashcards

Transfusion Reactions Flashcards

1
Q

Antigens of the blood that we produce antibodies against the ones we lack.

A

Blood Types
(A, B, AB, O)

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2
Q

What percentage of people are Rh+

A

85%

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3
Q

What percentage of people are Rh-

A

15%

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4
Q

In an emergency, can Rh+ be given to a patient that is Rh-

A

Only if they lack Rh antibodies
(Will likely become alloimmunized)

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5
Q

Most severe hemolytic transfusion reaction usually from ABO isoagglutinin

A

Acute Hemolytic Reaction

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6
Q

Is an Acute Hemolytic Reaction intravascular or extravascular?

A

Intravascular

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7
Q

What are some of the signs and symptoms of Acute Hemolytic Reaction?

A

Fever and Chills
Dyspnea
Tachycardia
Hemoglobinemia
Hemoglobinuria
Disseminated Intravascular Coagulation
Shock
Renal Failure
Death

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8
Q

How soon after transfusion does an Acute Hemolytic Reaction present?

A

Within 24 hours

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9
Q

How do you treat a patient with Acute Hemolytic Reaction?

A

IV Fluids + Mannitol to prevent Kidney Injury
Stop the Transfusion Immediately
Monitor for DIC with coagulation studies

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10
Q

What is the usual cause of Acute Hemolytic Reaction?

A

Mislabeling
Administered to Wrong Patient

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11
Q

Where do most severe Acute Hemolytic Reactions occur?

A

Operating Room

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12
Q

Reaction that is usually caused by minor Red Blood Cell antigen discrepancies.

A

Delayed Hemolytic Reaction

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13
Q

Is a Delayed Hemolytic Reaction intravascular or extravascular.

A

Extravascular

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14
Q

How soon after transfusion does a Delayed Hemolytic Reaction occur?

A

3 - 10 days

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15
Q

What are the symptoms of a Delayed Hemolytic Reaction?

A

May have no signs or symptoms
Usually less severe, but not always

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16
Q

What types of patients are susceptible to having a Delayed Hemolytic Reaction?

A

Previously sensitized patients that have low antibody levels and a negative alloantibody screen

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17
Q

How is a Delayed Hemolytic Reaction treated?

A

No specific treatment
May need additional transfusions

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18
Q

Most frequent transfusion reaction that occurs. Caused by Leukocyte rich products.

A

Febrile Non-hemolytic Transfusion Reaction
(Leukoagglutinin Reaction)

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19
Q

What patients are more susceptible to Febrile Non-Hemolytic Transfusion Reactions or Leukoagglutinin Reactions?

A

Patients with prior exposure to donor Leukocytes
(Transfusions or Pregnancy)

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20
Q

How much must the patients temperature increase by to be considered a Febrile Non-hemolytic Transfusion Reaction or Leukoagglutinin Reaction?

A

1° Celsius

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21
Q

How do you treat Febrile Non-hemolytic Transfusion Reactions or Leukoagglutinin Reactions?

A

Acetaminophen + Benadryl
(IV Corticosteroids may also be used)

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22
Q

How soon after a transfusion will anaphylaxis occur in a patient?

A

After a few mL of Blood

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23
Q

How do you treat an anaphylactic reaction due to a blood transfusion?

A

Stop the Transfusion Immediately
Administer Epinephrine
Glucocorticoids (if severe)

24
Q

What patients are at risk for anaphylaxis due to a blood transfusion?

A

IgA deficient patients
(should receive IgA deficient plasma)

25
Q

A disease where lymphocytes from the donor attack and cannot be eliminated by an immunodeficient host.

A

Graft-vs-Host Disease

26
Q

What are the signs and symptoms of Graft-vs-Host disease?

A

Fever
Rash
Diarrhea
Hepatitis
Marrow Aplasia
Severe Pancytopenia

27
Q

How soon after transfusion does Graft-vs-Host disease appear?

A

8 - 10 days

28
Q

What is the prognosis for Graft-vs-Host disease?

A

Usually fatal
(death occurs in 3 - 4 weeks)

29
Q

How can Graft-vs-Host disease be prevented?

A

Irradiation of Cellular Components

30
Q

Non-cardiogenic pulmonary edema that occurs within 6 hours of a blood product transfusion without other explanation.

A

Transfusion-Related Acute Lung Injury
(TRALI)

31
Q

What types of patients are most susceptible to Transfusion-Related Acute Lung Injury (TRALI)

A

Surgical and Critically ill with pre-existing lung disease

32
Q

What is the pathophysiology of Transfusion-Related Acute Lung Injury

A

Priming of neutrophils via inflammation of lung endothelial microvasculature

33
Q

How do you treat Transfusion-Related Acute Lung Injury?

A

Supportive Treatment
(usually resolves without complications)

34
Q

How can we prevent Transfusion-Related Acute Lung Injury (TRALI)

A

Male-only Plasma Donors
(women have more anti-leukocytes antibodies)

35
Q

Cardiogenic pulmonary edema that occurs within 6 hours of a blood transfusion.

A

Transfusion-Associated Circulatory Overload
(TACO)

36
Q

What causes Transfusion-Associated Circulatory Overload (TACO)

A

Excessive volume or rate of transfusion

37
Q

What are the signs and symptoms of Transfusion-Associated Circulatory Overload?

A

Respiratory Distress
Lower Extremity Swelling
Heart Failure

38
Q

What might be elevated in a patient with Transfusion-Associated Circulatory Overload?

A

Brain Natriuretic Peptide (BNP)
N-terminal-proBNP (NT-BNP)

39
Q

What are two patient-related risk factors for Transfusion-Associated Circulatory Overload (TACO)

A

Younger than 3
Older than 60
Pre-existing Cardiac Dysfunction

40
Q

How do you treat Transfusion-Associated Circulatory Overload?

A

Diuretics + Inotropes
Stop the Transfusion
Supportive Care

41
Q

Are viruses or bacteria more commonly transmitted during a blood transfusion?

A

Viruses

42
Q

Are platelets or red blood cells more likely to be contaminated and transmit disease?

A

Platelets
(stored at room temperature)

43
Q

An Rh- negative woman carries an Rh + fetus. The mother’s second pregnancy now poses a threat to a subsequent Rh+ fetus.

A

Hemolytic Disease of the Newborn

44
Q

A test used to determine whether there are antibodies to the Rh factor in the mother’s blood

A

Indirect Coomb’s Test

45
Q

When are women screened for blood type and Rh status?

A

First Prenatal Visit
28 Weeks

46
Q

When is the Indirect Coomb’s Test performed on a pregnant woman?

A

First Prenatal Visit
28 Weeks
40 Weeks

47
Q

If a mother’s Indirect Coomb’s Test is negative for antibodies against Rh factor, what should you administer?

A

Rhogam

48
Q

When is Rhogam administered to a Rh- mother that is not producing antibodies against Rh factor?

A

28 Weeks
40 Weeks
(or if more than 12 weeks since last dose)

49
Q

What does Rhogam do?

A

Destroy fetal Rh positive cells so the mother will not produce anti-Rh antibodies in the next pregnancy.

50
Q

If the mother is positive for antibodies against Rh factor, is Rhogam helpful?

A

No

51
Q

If a Rh- mother gives birth to an Rh+ baby, what should be administered to within 72 hours after delivery?

A

Rhogam

52
Q

How do you manage an Rh- mother with known maternal alloimmunization (antibody against Rh factor)

A

Determine fetal Rh
Monitor for fetal anemia if the baby is Rh+

53
Q

How do you treat a baby with Severe Fetal Anemia that is near term?

A

Delivery

54
Q

How do you treat a baby with Severe Fetal Anemia that is remote from term?

A

Intrauterine Fetal Transfusions

55
Q

Result of Hemolytic Disease of the Newborn that occurs prior to birth and causes heart failure, and large amount of fluid buildup. Risk for being stillborn

A

Hydrops Fetalis

56
Q

Result of Hemolytic Disease of the Newborn that occurs after birth and causes the most severe form of hyperbilirubinemia, a buildup of bilirubin in the baby’s brain. Can cause seizures, brain damage, deafness, and death.

A

Kernicterus

Clinical Medicine: Hematology and Oncology (8 decks)

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