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Liz's Blood Bank Module 2 > Transfusion Reactions > Flashcards

Transfusion Reactions Flashcards

1
Q

Diverse group of unfavorable transfusion related events taht occur during or after transfusion of blood and blood components

A

Transfusion reactions

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2
Q

Which transfusion rxn occurs w/ the transfusion of incompatible RBCs (most common) or plasma products that is immune mediated and results in intravascular or extravascular hemolysis?

A

Hemolytic transfusion reactions

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3
Q

Which transfusion rxn occurs where the immune system is a common pathway but intravascular and extravascular hemolysis doesn’t occur?

A

Nonhemolytic transfusion reaction

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4
Q

Immediate/acute transfusion rxn occurs when?

A

During or w/in 24 hours of transfusion

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5
Q

Delayed transfusion rxn occurs when?

A

Several days to weeks after transfusion

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6
Q

List the two hemolytic reactions

A
  1. Acute intravascular (ABO Abs)

2. Delayed extravascular (IgG Abs)

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7
Q

List the 5 immediate nonhemolytic rxns

A
  1. Febrile
  2. Allergic/anaphylactic
  3. TRALI
  4. TACO
  5. Bacterial
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8
Q

List the 5 delayed nonhemolytic rxns

A
  1. Alloimmunization
  2. Post transfusion purpura (PTP)
  3. Transfusion-related GVHD
  4. Iron overload
  5. Disease transmission
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9
Q

Abs associated w/ IHTRs and DHTRs

A

IHTRs: intravascular → IgM (ABO)
DHTRs: extravascular → IgG (Rh, Kell, Kidd, Duffy, SsU)

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10
Q

What is the most common cause of preventable hemolytic transfusion reactions?

A

Clerical error

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11
Q

Bedside procedures in the event of a suspected transfusion reaction (8)

A
  1. STOP TRANSFUSION
  2. Clerical check
  3. Call MD
  4. Call BB
  5. Draw EDTA
  6. Send EDTA, donor bag, tubing paperwork, and order to BB
  7. Send 1st UA if AHTR is suspected
  8. Keep IV lines open
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12
Q

Describe steps to follow in a lab investigation of a suspected transfusion reaction

A
  • Clerical check and attached solution
  • Centrifuge post-transfusion sample to assess for visual hemoglobinemia (compre to pre-transfusion sample)
  • DAT performed on post-transfusion EDTA sampel
  • Additional workup based on results of the above 3 items AND clinical symptoms of patient
  • Perform DAT
  • If >2°C temp rise, send bag to micro for culture
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13
Q

Why will a DAT will be either positive or negative in an acute HTR?

A

Negative if there is not an Ab-Ag rexn and positive if there is!

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14
Q

What is the characteristic appearance of the DAT when an acute or delayed HTR has occurred?

A

Positive/hemolyzed

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15
Q

Explain why a IAT on a post-reaction serum sample may be negative following the infusion of Ag positive blood to an individual w/ corresponding Ab

A

?

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16
Q

Most common transfusion-associated disease

A

Hepatitis

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17
Q

If a patient should come down with Hepatitiis or HIV suspected to be due to blood transfusion, the hospital should follow a reporting process. Hospital > notifies Blood center > notifies donor > gets retested > and Blood center > notifies hospital of results > notifies other facilities that used products

A

“Look-back” process

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18
Q

What 2 tests are diagnostic for a transfusion reaction?

A
  • DAT

- Visual hemoglobin

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19
Q

Abnormally rapid heart rate

A

Tachycardia

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20
Q

Shortness of breath (SOB)

A

Dyspnea

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21
Q

FNHTR

A

Febrile nonhemolytic transfusion reaction

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22
Q

TRALI

A

Transfusion related acute lung injury

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23
Q

TACO

A

Transfusion associated circulatory overload

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24
Q

PTP

A

Post-transfusion (thrombocytopenic) purpura

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25
Q

TA-GVHD

A

Transfusion-associated graft vs. host disease

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26
Q

A rash of round, red welts on the skin that itches intensely, sometimes w/ dangerous swelling, caused by an allergic reaction, typically to specific foods

A

Urticaria

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27
Q

Unpleasant sensation of the skin that provokes the urge to scratch. It’s a characteristic feature of many skin diseases and an unusual sign of some systemic diseases

A

Pruritis

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28
Q

Superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilation of the blood capillaries

A

Erythema

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29
Q

An immune response generated in an individual or strain of one species by an alloantigen from a different individual or strain of the same species

A

Alloimmunization

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30
Q

Accumulation of iron in the liver and/or heart but also endocrine organs, in patients who recieve frequent blood transfusions (such as those w/ thalassemia, sickle cell disease, aplastic anemia or MDS)

A

Transfusion hemosiderosis

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31
Q

“White-out” caused by changes in permeability of the pulmonary capillary membrane as a result of either a direct or an indirect pathologic insult

A

Noncardiogenic pulmonary edema

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32
Q

Condition that occurs due to a rapid transfusion of a large volume of blood

A

Circulatory overload

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33
Q

Therapy for an allergic reaction

A

Antihistamines (Benadryl)

34
Q

Therapy for febrile reaction

A

Acetaminophen

35
Q

Therapy for anaphylactic reaction

A

Epinephrine

36
Q

Therapy for febrile reaction w/ ↓ platelets

A

Acetaminophen

37
Q

Therapy for bacterial contamination reaction

A

Broad spectrum antibiotics

38
Q

Therapy for urticaria reaction

A

Antihistamines (Benadryl)

39
Q

Therapy for iron overload

A

Desferrioxamine (iron-chelating agent)

40
Q

Cause of immediate HTR

A

ABO Abs

41
Q

Therapy for TACO

A
  • Oxygen therapy
  • Diuretics/digoxin
  • Slow transfusion
42
Q

Cause of delayed HTR

A

Anti-Jka

43
Q

Cause of febrile reaction

A

HLA Abs present in patient’s plasma

44
Q

Cause of allergic reaction

A

Patient’s reaction to transfused plasma proteins of donor

45
Q

Cause fo anaphylactic reaction

A

Recipient lacks IgA and has anti-IgA Abs

46
Q

Cause of TRALI

A

Donor or recipient has anti-HLA Abs and female plasma donors (multiple pregnancies, therefore multiple exposures to foreign HLA/neutrophil Ags)

47
Q

Cause of TACO

A

Transfusion is too fast → volume overload

48
Q

Cause of bacterial contamination

A
  • Yersinia enterocolitica (most common), E. coli, and Pseudomonas spp. prefer to grow in RBCs
  • GPCs (Staphylococcus and Streptococcus) like the warm environment provided by platelets
49
Q

Cause of post-transfusion purpura (PTP)

A

Involves Ab to platelet Ag, usually HPA-1A (almost everyone positive for Ag) → anti-PL^A1

50
Q

Cause of TA-GVHD

A

Donor T lymphocytes attack recipient

51
Q

Cause of iron overload

A

Complication of long-term RBC transfusions → “transfusion hemosiderosis”

52
Q

Alternate name for immediate HTR

A

Acute intravascular reaction

53
Q

Alternate name for delayed HTR

A

Delayed extravascular reaction

54
Q

Alternate name for febrile reaction

A

FNHTR

55
Q

Alternate name for allergic reaction

A

Urticarial reaction

56
Q

Alternate name for TRALI

A

Noncardiogenic pulmonary edema

57
Q

Alternate name for TACO

A

Circulatory overload

58
Q

Alternate name for iron overload

A

Transfusion hemosiderosis

59
Q

Blood product for delayed HTR

A

Ag negative RBCs

60
Q

Blood product for febrile reaction

A

Leukoreduced products

61
Q

Blood product for allergic reaction

A

Washed or frozen RBCs

62
Q

Blood product for anaphylactic reaction

A

Washed or deglyc’d RBCs or IgA deficient products

63
Q

Blood product for TRALI

A

Plasma from male donors

64
Q

Blood product for TA-GVHD

A

Irradiated products

65
Q

Fever, bleeding, tachycardia, hypotension, low back pain, dyspnea, hemoglobinuria, feeling of “impending doom”, death

A

Immediate hemolytic

66
Q

Fever/chils, mild jaundice, anemia

A

Delayed hemolytic

67
Q

↑ temperature > or equal to 1°C or 2°F, chills

A

Febrile (non-hemolytic)

68
Q

Urticaria, pururitis, flushing

A

Allergic reaction

69
Q

Severe dyspnea, tachycardia, hypotension

A

Anaphylactic

70
Q

Dyspena, chills, fever, HYPOtensive, pulmonary edema, “white out”

A

TRALI

71
Q

Dyspnea, cyanosis, pulmonary edema, HYPERtension

A

TACO

72
Q

Rapid onset of high fever, sepsis (bacteremia w/ concomitant hypotension, DIC), violent rigors, dyspnea, shock, death

A

Bacterial contamination

73
Q

Thrombocytopenia

A

Post-transfusion purpura (PTP)

74
Q

Skin (rash and/or sloughing off of skin), GI (diarrhea), BM (pancytopenia), Hepatitis, dermatitis, enteritis

A

TA-GVHD

75
Q

Accumulation of iron affects function of heart, liver, and endocrine glands

A

Iron overload

76
Q

LAB: DAT+, hemoglobinemia, ↑ bili and LDH, ↓ haptoglobin, hemoglobinuria

A

Immediate hemolytic

77
Q

LAB: DAT+, IAT+, spherocytes

A

Delayed hemolytic

78
Q

Febrile (nonhemolytic), allergic, anaphylactic, TRALI, TACO, and TA-GVHD are ONLY DAT ____

A

Negative

79
Q

LAB: product discolored, patient DAT negative, hemoglobinemia, hemoglobinuria, and culture product positive

A

Bacterial contamination

80
Q

LAB: extremely low platelet count, DAT negative

A

PTP

81
Q

LAB: DAT negative, diagnosed w/ ferritin levels

A

Iron overload

Liz's Blood Bank Module 2 (8 decks)

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