Transfusion reactions

Question 1

when does a febrile transfusion reaction manifest?

Answer 1

up to 4 hours after the transfusion

Question 2

what is the prevention for febrile transfusion reaction?

Answer 2

leukoreduction

Question 3

allergic transfusion reactions are almost always due to what cause?

Answer 3

1. preformed IgE

2. almost always due to plasma or platelets (because of the plasma they are stored in)

Question 4

what is the pathophysiology of anaphylaxis following a transfusion?

Answer 4

IgA deficient patient with an antibody to the IgA in the component

Question 5

does pretreatment for allergic transfusion reactions work?

Answer 5

no

Question 6

how does transfusion associated circulatory overload (TACO) most often present?

Answer 6

increased BP and HR

Question 7

what is the pathophysiology of transfusion related acute lung injury (TRALI)?

Answer 7

1. hit 1 - neutrophil sequestration and priming - lung microvascular endothelial injury
2. hit 2 - neutrophil activation by factor in received component - pulmonary edema

Question 8

when does transfusion related acute lung injury (TRALI) present?

Answer 8

less than 6 hours from transfusion initiation

Question 9

what are the diagnostic criteria for TRALI?

Answer 9

1. onset during or within 6 hours of transfusion cessation
2. oxygen saturation less than 90% on room air
3. radiological evidence of bilateral infiltrates

Question 10

what is the treatment for TRALI?

Answer 10

1. oxygen supplementation with or without mechanical support
2. pressors
3. NO DIURETICS

Question 11

how does TACO differ from TRALI?

Answer 11

1. TACO patients are already at risk of volume overload
2. TACO patients usually have high BP
3. TRALI patients have fever and chills
4. TRALI patients have hypotension

Question 12

what is the pathophysiology of hemolytic transfusion reaction?

Answer 12

antibody directed against Kidd RBC antigen

Question 13

what is the cause of transfusion transmitted bacterial infection (TTBI)?

Answer 13

usually platelets (stored at room temperature - better for bacterial growth)

Question 14

what is the leading cause of transfusion related mortality in the US?

Answer 14

TRALI

Question 15

which transfusion reactions may present with fever?

Answer 15

1. febrile TR
2. TRALI
3. acute hemolytic
4. TA-GVHD
5. TTBI

Question 16

in what clinical situations is Rho(D) immunoglobulin given?

Answer 16

1. NOT when mother has already formed an anti-D
2. when mother is Rh- and father is known to be Rh+
3. when mother is RH- and father’s Rh status is unknown
4. if infant is known to be Rh+
5. specific circumstances such as abortion, ectopic pregnancy, invasive procedures, blunt abdominal trauma