transfusion rxn

Question 1

non hemolytic rxns examples

Answer 1

febrile
allergic
anaphylactic
TACO
TRALI
GVHD
transfusion transmitted disease
alloimmunization
transfusion induced hemosiderosis
PTP

Question 2

hemolytic transfusion rxn examples

Answer 2

immediate intravascular hemolysis
immediate extravascular hemolysis
delayed extravascular hemolysis

Question 3

non hemolytic transfusion rxn overview

Answer 3

96% of all rxns

Question 4

febrile non hemolytic transfusion rxn

Answer 4

> 1 degree C rise in temp
1% of transfusions
caused by anti-WBC Ab
fever, chills
use leukoreduced products

Question 5

allergic non hemolytic trans rxns

Answer 5

rxn to donor plasma
20% of all rxns
itching, hives, edema
use plasma free products

Question 6

anaphylactic non hem. trans. rxns

Answer 6

allo anti-IgA Ab
mild allergic rxn, shock, death
use plasma free prods, IgA free

Question 7

TACO non hem. trans. rxn

Answer 7

transfusion associated circulatory overload
chest pain, dyspnea, cough, heart failure
infuse more slowly

Question 8

TRALI non hem. trans, rxn

Answer 8

anti-WBC Ab
damage to lung tissue
chills, cough, fever, respiratory failure

Question 9

graft vs host disease trans rxn

Answer 9

donor Tcells attack immunocompromised patient
pancytopenia, fever, abn. liver fxn
give irradiated products

Question 10

transfusion transmitted disease

Answer 10

hepatitis
HIV
HTLV
west nile virus
CMV & EB
Malaria
babesiosis
chaga’s disease
toxoplasmosis
rocky mt. spotted fever
syphilis

Question 11

transfusion induced hemosiderosis

Answer 11

iron overload

Question 12

PTP

Answer 12

post transfusion purpura
platelet allo-antibodies
depletion of plts and coag factors

Question 13

complications associated with massive transfusion

Answer 13

citrate toxicity
hypothermia
dilutional thrombocytopenia

Question 14

hemolytic transfusion rxns overview

Answer 14

4% of rxns
intravascular vs extravascular
immediate vs delayed

Question 15

immediate intravascular hemolysis

Answer 15

IgM complement activating Ab
IgG Ab
ABO mix up
within 2 hrs: fever, chills, renal shutdown, DIC, hemoglobinemia
10% mortatlity
supportive treatment

Question 16

immediate extravascular hemolysis

Answer 16

occurs within 2 hrs
fever, chills, renal shutdown, DIC, NO HEMOGLOBINEMIA

Question 17

Delayed extravascular hemolysis

Answer 17

anamnestic response or Ab production
Rh Ab
Anti-Jka
Anti-K
Anti-Fya
3-7 days post transfusion, hgb/hct decrease, mild sx fever chills jaundice
supportive treatment

Question 18

physical damage to transfused cells

Answer 18

heat damage (warmers, storage)
physical damage (pumps, heart valves)

Question 19

microbe contamination of donor units- most common microbes

Answer 19

Yersinia entercolitica
Pseudomonas
E. coli

Question 20

microbe contamination of donor units

Answer 20

looks brown, purple, chunks
sx: rapid onset, fever, chills, DIC, shock, death
IV Antibiotics
visual inspection of units

Question 21

evaluation of suspected rxn patient care personnel resposibilities

Answer 21

take vital signs
stop transfusion
keep IV line open
notify Dr & transfusion service
bedside clerical check
document info
treat patient w/ antihistamines- cont. trans or send unit to lab

Question 22

evaluation of suspected rxn lab personnel resposibilities

Answer 22

clerical check
observe pre and post for hemolysis
serum/plasma Hgb
GS/ culture
DAT on post- if + DAT on pre
proceed to extended eval if hemolysis, or new DAT

Question 23

extended eval of trans. rxn is needed if…

Answer 23

discrepancy in clerical check
Post DAT+, pre DAT=
visual hemolysis
post serum hgb >20 mg/dl more than pre

Question 24

extended eval

Answer 24

Pre and Post: ABO/Rh, IAT, Crossmatch
Lab seg from donor unit: ABO/Rh, Ag type if Ab ID’d
urine hgb
serum bilirubin
plasma hgb
haptoglobin
cultures