Transfusion Reactions

Question 1

Differentiating chronic versus acute on chronic kidney injury?

Answer 1

Chart 1/Creatinine versus time

If chronic kidney disease – downward sloping line

If acute on chronic – stepwise downward sloping line

Question 2

When to transfuse platelets?

Answer 2

Platelet transfusion if:

#Under 10 – always
#Under 50 – if planned procedure or active bleeding
#Under 100 – planned procedure in a closed space

Question 3

Red blood cell transfusion if?

Answer 3

#Under 7
#under 9 with cardiopulmonary pathology
#Blood loss over 20%

Question 4

Therapeutic dosing of FFP?

Answer 4

10 mL/kg over 4-6 hours

Question 5

Red blood cell transfusion - modifiers?

Answer 5

#Reduced (under 5 WBC per product) – decreases nonhemolytic transfusion reactions
#Irradiated – for graft versus host disease
#Washed – decreased antibodies (for IgA deficiency)
#Sickle negative

Question 6

TACO vs TRALI?

Answer 6

Transfusion associated cardiac overload (fluid overload like CHF)

Transfusion related acute lung injury

Question 7

Least concerning transfusion reaction? Typical presentation? Underlying pathophysiology due to?

Answer 7

Febrile nonhemolytic transfusion reaction

#Temperature increase by 1-2°C
#Chills/nausea/vomiting

Cytokines

Question 8

Most concerning transfusion reaction? Usually do to?

Answer 8

Hemolytic transfusion reaction

Mismatched blood

Question 9

Transfused patient develops urticaria alone – cause? Prevent with?

Answer 9

Antibody to donor Pro Tien

Antihistamines

Question 10

Treatment of TACO?

Answer 10

#Diuretics (for CHF symptoms)
#CPAP to decrease load on heart (increases Intrathoracic pressure)

Question 11

Signs of TRALI? Treatment?

Answer 11

#crackles
#Reduced JVP
#Septic like fever

Supportive

Question 12

Signs of graft versus host disease? Prevent with?

Answer 12

Maculopapular rash, fever

Irradiated blood products

Question 13

Management of valvular versus nonvalvular atrial fibrillation?

Answer 13

Always anticoagulate versus use CHADS2