Transfusion Rxns Clinical Flashcards
TFRXN
workup path?
who IDs/Works up….etc
Unfavorable response to infusion of blood or blood products
first ID’s by infusionist
worked up by blood banker
classified by pathologist
treated by doctor
Workup
ABO/Rh both pre and post
post can have mixed field
DAT on post IgG + C3B
look for hemolysis
Hemolytic
destruction of?
related?
destruction of rbcs
product related
Non hemolytic
other organs affected
Acute
adverse immediately upon transfusion
product related
Delayed
> 24hr after transfusion, Anti Kidd common
Signs and symtoms of Transfusion rxn
hemolysis
increased temp
bp change
shortness of breath
pain
limited survival of product
Hemolysis
hemogl
hemogl
what doesnt rise?
what is POS?
what on slide?
hemoglobinuria
hemoglobinemia
Hgb level doesnt rise
DAT POS
Agglutination on slide
Raise in temp
fevers, chills, nausea, vomit
Bp
types
hypotension - down - shock
Hypertention: Up - jugular vein dissention
Shortness of breath
wheezing anaphylaxis hypoxemia, angioedema
Pain
back pain
at infusion site
impending doom
uticaria
Non immune causes of hemolysis
improper
incomplete
rapid
improper bl
hypo
anything
improper shipping temp
incomplete deglycerolized rbcs
rapid pressure infuser
improper blood warmer
hypotonic solutions
anything other than saline
Acute hemolytic
what happens? what is activated? casues?
immunoglobulins? groups?
hemolyzed, compliment,DIC renal failure
IgM > IgG
ABO Rh kell
Delayed hemolytic
causes?
what drops?
D?
mild?
immunoglobulin?
what immunoglobulin groups?
fever, DAT, H/H drop, mild jaundice
IgG
Kidd, duffy, kell, MNS
FN HTR
febrile non hemolytic rxn
prevent?
causes what symptoms?
caused by?
lab results?
treatment?
prevent w leukoreduced products
fever, nausea, tachycardia, BP increased
Caused by wbc derrived HLA abs in PLTs
NEG DAT, no visible hemolysis
treat w tylenol
Allergic rxns
prevention?
symptoms?
all….what in donor product? (what immunoglobulin in which product?)
DAT? hemolysis?
Treatment
prevention: use diff donor products
symtpoms urticaria, itching
allergens, proteins in donor products (IgA in plasma)
NEG DAT, no visible hemolysis
Antihistamine
TA GVHD
prevent by irr….to
key feature? mortality? symptom?
why?
causes p/l
treatment? sc/im
prevent by irradiating cellular products to inactivate donor lymphs
Macropapular rash, 90% mortality, diarrhea
recipient doesnt recogn donor lymphs as foregin, causes immune response
pancytopenia, lymph infiltrates
SC transplant/immunosuppressants
TRALI
transfusion associated lung injury
increase donor deferrals for….
causes severe,s,h
from? in what product?
stop? suppliment?
prevent: increase donor deff for females who have been pregnant and males who have been transfused
Severe respiratory distress, shortness of breath, hypotension
WBC ab (HLA) plasma products
stop transusion, 02 suppliment
TACO
prevent by?
causes d,c,h
underlying?
elevated? no?
prevent: check lab val before transf
dyspenea, coughing, hypertension
underlying cardiopulmonary path overload
elevated BNP no hemolysis
Who is at risk from reciveing plasma from a multiparous female?
TRALI
Who is at risk from low circ/heart output?
TACO
Who is at risk for immune compromised
GVMD
Sepsis
caused by what product?
causes …symptoms?
blood..
body temp?
ID/Ab
PLTs/storage (RT)
rigors + hypertension
blood culture
body temp >2 degrees of normal
ID contam/antibiotics
iron overload (Hemosiderosis)
prevent by?
causes..y/m
accumulation of
increased
theraputic?
prevent: <20 rbcs a yr or washed cells
yellowing skin, multiorgan failure
Accumulation of iron in tissues
increased ferritin
theraputic phleb
Citrate toxicity
what sensation
inability?
prevent: ingestion of calcium
tingling/prickling sensation
inability of liver to metabolize
PTT post transfusion purpura
what crossmatch? what matched transfusion?
causes?
pt has? usually?
what products administered?
PLT crossmatch/HLA matched plt transfusion
thrombocytopenia
pt has plt ab, usually Anti-HPA1
IVIG pooled products
Report to FDA
Sepsis, TRALI, hemolytic
